Appendix I - Form of International Ballast Water Management Certificate
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Statutory Documents - IMO Publications and Documents - International Conventions - BWM - International Convention for the Control and Management of Ships' Ballast Water and Sediments, 2004 - Annex - Regulations for the Control and Management of Ships' Ballast Water and Sediments - Appendix I - Form of International Ballast Water Management Certificate

Appendix I - Form of International Ballast Water Management Certificate

INTERNATIONAL BALLAST WATER MANAGEMENT CERTIFICATE
       
Issued under the provisions of the International Convention for the Control and Management of Ships' Ballast Water and Sediments (hereinafter referred to as "the Convention") under the authority of the Government of
………………………………………………………………………………………………
  (full designation of the country)
by ……………………………………….…………………………………………………
  (full designation of the competent person or organization authorized under the provisions of the Convention)
Particulars of ship footnote
  Name of ship ...........................................................................................................
  Distinctive number or letters ...................................................................................
  Port of registry ........................................................................................................
  Gross Tonnage ........................................................................................................
  IMO numberfootnote ..........................................................................................................
  Date of Construction ………………………………………………………………
  Ballast Water Capacity (in cubic metres) ...............................................................
Details of Ballast Water Management Method(s) Used
Method of ballast water management used ……………………………………………...
  Date installed (if applicable) (dd/mm/yyyy)......................................................
  Name of manufacturer (if applicable) ....................................................................
The principal ballast water management method(s) employed on this ship is/are:
  in accordance with regulation D-1
  in accordance with regulation D-2 (describe) .....................................................................................................
  the ship is subject to regulation D-4
  other approach in accordance with regulation .......................................
       
THIS IS TO CERTIFY:
1

That the ship has been surveyed in accordance with regulation E-1 of the Annex to the Convention; and

2

That the survey shows that Ballast Water Management on the ship complies with the Annex to the Convention.

This certificate is valid until …………………………… subject to surveys in accordance with regulation E-1 of the Annex to 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 AND INTERMEDIATE SURVEY(S)
THIS IS TO CERTIFY that a survey required by regulation E-1 of the Annex to the Convention the ship was found to comply with the relevant provisions of the Convention:
Annual survey: Signed ...........................
  (Signature of duly authorized official)
  Place ............................
  Date...........................…
(Seal or stamp of the authority, as appropriate)
Annualfootnote/Intermediate surveyfootnote: Signed ...........................
  (Signature of duly authorized official)
  Place ............................
  Date...........................…
(Seal or stamp of the authority, as appropriate)
Annualfootnote/Intermediate surveyfootnote: Signed ...........................
  (Signature of duly authorized official)
  Place ............................
  Date...........................…
(Seal or stamp of the authority, as appropriate)
Annual survey: Signed ...........................
  (Signature of duly authorized official)
  Place ............................
  Date...........................…
(Seal or stamp of the authority, as appropriate)
ANNUAL / INTERMEDIATE SURVEY IN ACCORDANCE WITH REGULATION E-5.8.3
THIS IS TO CERTIFY that, at an annual / intermediatefootnote survey in accordance with regulation E-5.8.3 of the Annex to the Convention, the ship was found to comply with the relevant provisions 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 REGULATION E-5.3 APPLIES
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation E-5.3 of the Annex to 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 REGULATION E-5.4 APPLIES
The ship complies with the relevant provisions of the Convention and this Certificate shall, in accordance with regulation E-5.4 of the Annex to 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 REGULATION E-5.5 OR E-5.6 APPLIES
This Certificate shall, in accordance with regulation E-5.5 or E-5.6 footnote of the Annex to 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 REGULATION E-5.8 APPLIES
In accordance with regulation E-5.8 of the Annex to 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 regulation E-5.8 of the Annex to the Convention the new Anniversary date is …………….
  Signed ..........................
  (Signature of authorized official)
  Place ............................
  Date........................…...
(Seal or stamp of the authority, as appropriate)
Parent topic: Annex - Regulations for the Control and Management of Ships' Ballast Water and Sediments
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