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Polar Ship Certificate
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This Certificate shall be supplemented by a
Record of Equipment for the Polar Ship Certificate
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(Official seal)
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(State)
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Issued under the provisions of the
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International Convention for the Safety of Life
at Sea, 1974, as amended
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under the authority of the Government of
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(name of the State)
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by
____________________________________________________________
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(person or organization
authorized)
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Particulars of shipfootnote
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Name of
ship
..
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Port of
registry
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Distinctive number or
letters
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Gross
tonnage
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IMO Numberfootnote
...
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This is to certify:
1 That the ship has been surveyed in
accordance with the applicable safety-related provisions of the International Code
for Ships Operating in Polar Waters.
2 That the surveyfootnote showed that the structure, equipment,
fittings, radio station arrangements, and materials of the ship and the condition
thereof are in all respects satisfactory and that the ship complies with the
relevant provisions of the Code.
Category A/B/Cfootnote ship as follows:
Ice Class and Ice Strengthened Draft Range
Ice class
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Maximum draft
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Minimum draft
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Aft
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Fwd
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Aft
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Fwd
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2.1 Ship type: tanker/passenger
ship/otherfootnote
2.2 Ship restricted to operate in ice free
waters/open waters/other ice conditionsfootnote
2.3
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Ship intended to operate in low air temperature:
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Yes/Nofootnote
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2.3.1
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Polar Service Temperature:
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..°C/Not Applicablefootnote
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2.4
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Maximum expected time of rescue
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.days
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3 The ship was/was notfootnote subjected to an alternative design and arrangements in
pursuance of regulation(s) XIV/4 of the International Convention for the Safety of
Life at Sea, 1974, as amended.
4 A Document of approval of alternative
design and arrangements for structure, machinery and electrical installations/fire
protection/life-saving appliances and arrangementsfootnote is/is notfootnote appended to this Certificate.
5 Operational limitations
The ship has been assigned the following limitations for operation in polar
waters:
5.1 Ice conditions: ...............................................................................................
- .......................................................................................................................
5.2 Temperature:
................................................................................................
5.3 High latitudes:
...............................................................................................
This certificate is valid until . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . subject to the annual/periodical/intermediate
surveys in accordance with section 1.3 of the Codefootnote
Completion date
of the survey on which this certificate is based:. . . . . . . . . .
. . . . .
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(dd/mm/yyyy)
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Issued at . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
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(Place of issue of certificate)
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. . . . . . . . . . . . . . .
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(Date of issue)
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(Signature of authorized official
issuing the certificate)
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(Seal or stamp of the issuing authority, as
appropriate)
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Endorsement for annual, periodical and intermediate surveysfootnote
THIS IS TO CERTIFY that, at a survey
required by regulation 1.3 of the Code, the ship was found to
comply with the relevant requirements of the Code.
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Annual survey:
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Signed:
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(Signature of authorized official)
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Place:
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Annual/Periodical/Intermediatefootnote survey:
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Signed:
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(Signature of authorized official)
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Place:
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Date:
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Annual/Periodical/Intermediatefootnote survey:
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Signed:
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(Signature of authorized official)
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Place:
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Annual survey:
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Signed:
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(Signature of authorized official)
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Place:
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Endorsement to extend the certificate if valid for less than 5
years where regulation I/14(c) of the Convention appliesfootnote
The ship complies with the relevant
requirements of the Convention, and this certificate shall, in
accordance with regulation I/14(c) of the Convention, be
accepted as valid until.................
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Signed:
.................................................................
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(Signature of authorized official)
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Place:
...................................................................
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Date:
.....................................................................
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(Seal or stamp of the authority, as
appropriate)
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Endorsement where the renewal survey has been completed and
regulation I/14(d) of the Convention appliesfootnote
The ship complies with the relevant
requirements of the Convention, and this certificate shall, in
accordance with regulation I/14(d) of the Convention, be
accepted as valid until.................
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Signed:
.................................................................
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(Signature of authorized official)
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Place:
...................................................................
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Endorsement to extend the validity of the certificate until
reaching the port of survey or for a period of grace where
regulation I/14(e) or I/14(f) of the Convention appliesfootnote
This certificate shall, in
accordance with regulation I/14(e)/l/14(f)footnoteof the Convention, be accepted as
valid until............................
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Signed:
.................................................................
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(Signature of authorized official)
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Place:
...................................................................
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Endorsement to extend the validity of the certificate until
reaching the port of survey or for a period of grace where
regulation I/14(e) or I/14(f) of the Convention appliesfootnote
In accordance with regulation
I/14(h) of the Convention, the new anniversary date is
..............
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Signed:
.................................................................
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(Signature of authorized official)
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Place:
...................................................................
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Date:
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(Seal or stamp of the authority, as
appropriate)
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In accordance with regulation
I/14(h) of the Convention, the new anniversary date is
..............
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Signed:
.................................................................
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(Signature of authorized official)
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Place:
...................................................................
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Date:
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(Seal or stamp of the authority, as
appropriate)
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Record of Equipment for the Polar Ship Certificate -
This record shall
be permanently attached to the Polar Ships Certificate
Record Of Equipment
For Compliance With The International Code For Ships Operating In Polar
Waters
1 Particulars of ship:
Name of ship:
Distinctive number or letters:
..
2 Record of equipment
2.1 Life-saving appliances
1
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Total number of immersion suits with
insulation:
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.........................
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1.1
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for crew
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.........................
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1.2
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for passengers
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.........................
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2
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Total number of thermal protective aids
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.........................
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3
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Personal and Group Survival Equipment
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.........................
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3.1
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Personal survival
equipment for number of persons
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.........................
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3.2
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Group survival
equipment for number persons
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.........................
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3.3
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Total capacity of
liferafts in compliance with chapter 8 of the Polar Code
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3.4
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Total capacity of
lifeboats in compliance with chapter 8 of the Polar Code
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2.2
Navigation equipment
1
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Two independent
echo-sounding devices or a device with two separate independent
transducers
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.........................
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2
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Remotely rotatable,
narrow-beam search lights controllable from the bridge or other
means to visually detect ice
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.........................
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3
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Manually initiated flashing
red light visible from astern (for ships involved in icebreaking
operations)
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.........................
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4
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Two or more non-magnetic
independent means to determine and display heading
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.........................
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5
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GNSS compass or equivalent
(for ships proceeding to latitudes over 80 degrees)
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2.3 Communication equipment
1
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Sound signaling system
mounted to face astern to indicate escort and emergency
manoeuvres to following ships as described in the International
Code of Signals (for ships intended to provide ice breaking
escort).
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...
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2
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Voice and/or data
communicatons with the relevant rescue coordination
centres
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3
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Equipment for voice
communications with aircraft on 121.5 and 123.1 MHz.
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4
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Two-way voice and data
communication with a Telemedical Assistance Service (TMAS).
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5
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All rescue boats and
lifeboats, whenever released for evacuation, have a device (for
ships certified to operate in low air temperature):
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5.1
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for
transmitting vessel to shore alerts;
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5.2
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for
transmitting signals for location;
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5.3
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for
transmitting and receiving on-scene communications.
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6
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All
other survival craft have a device:
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6.1
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for
transmitting signals for location; and
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6.2
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for
transmitting and receiving on-scene communications.
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THIS IS TO CERTIFY that this Record is correct in all
respects:
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Issued
at
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(Place of issue of the
Record)
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(Date of
issue)
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Signature of duly
authorized official issuing the Record)
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(Seal or stamp of the issuing authority, as
appropriate)
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