Form of International Exemption Certificate on Load Lines
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - International Conventions - Load Lines, 1966/1988 - International Convention on Load Lines, 1966, as Amended by the Protocol of 1988 - Annex III - Certificates - Form of International Exemption Certificate on Load Lines

Form of International Exemption Certificate on Load Lines

INTERNATIONAL LOAD LINE EXEMPTION CERTIFICATE
           
(official seal)     (State)
  Issued under the provisions of the INTERNATIONAL CONVENTION ON LOAD LINES, 1966, as modified by the Protocol of 1988 relating thereto  
 
under the authority of the Government of
  ___________________________________________________________  
  (name of the State)  
by ___________________________________________________________  
  (person or organization recognized)  
 
Particulars of ship footnote
Name of ship ..........................................................................................................................................................................................
Distinctive number or letters ...............................................................................................................................................................
Port of registry .......................................................................................................................................................................................
Length (L) as defined in article 2(8) (in metres) ..............................................................................................................................
IMO Numberfootnote.......................................................................................................................................................................................
 
THIS IS TO CERTIFY:
That the ship is exempted from the provisions of the Convention, under the authority conferred by article 6(2)/6(4) footnote of the Convention referred to above.
The provisions of the Convention from which the ship is exempted under article 6(2) are:
...................................................................................................................................................................................................................
The voyage for which exemption is granted under article 6(4) is:
From: ........................................................................................................................................................................................................
To: .............................................................................................................................................................................................................
Conditions, if any, on which the exemption is granted under either article 6(2) or article 6(4):
...................................................................................................................................................................................................................
This certificate is valid until ...........................................footnote subject to annual surveys in accordance with article 14(1)(c) of the Convention.
Completion date of the survey on which this certificate is based: ....................................
(dd/mm/yyyy)
Issued at ..................................................................................................................................................................................................
(Place of issue of certificate)
..................................................................   .......................................................................................................
(Date of issue)   (Signature of authorized official issuing the certificate)
(Seal or stamp of the authority, as appropriate)
Endorsement for annual surveys
       
THIS IS TO CERTIFY that, at an annual survey required by article 14(1)(c) of the Convention, the ship was found to comply with the relevant requirements of the Convention.
Annual Survey:   Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Annual Survey:   Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Annual Survey:   Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Annual Survey:   Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
Annual survey in accordance with article 19(8)(c)
       
THIS IS TO CERTIFY that, at a survey in accordance with article 19(8)(c) of the Convention, the ship was found to comply with relevant requirements of the Convention
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Endorsement to extend the certificate if valid for less than 5 years where article 19(3) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with article 19(3) of the Convention, be accepted as valid until ...................................................................................
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Endorsement where the renewal survey has been completed and article 19(4) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with article 19(4) of the Convention, be accepted as valid until ...................................................................................
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Endorsement to extend the validity of the certificate until reaching the port of survey or for a period of grace where article 19(5) or 19(6) applies
This certificate shall, in accordance with article 19(5)/19(6) footnote of the Convention, be accepted as valid until .....................................................................
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
Endorsement for advancement of anniversary date where article 19(8) applies
In accordance with article 19(8) of the Convention the new anniversary date is ....................................................
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
 
In accordance with article 19(8) of the Convention the new anniversary date is ....................................................
    Signed ......................................................................................................
    (Signature of authorized official)
    Place .........................................................................................................
    Date ..........................................................................................................
(Seal or stamp of the authority, as appropriate)
* Delete as appropriate.
Parent topic: Annex III - Certificates
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