| INTERNATIONAL AIR POLLUTION PREVENTION EXEMPTION CERTIFICATE
FOR UNMANNED NON-SELF-PROPELLED (UNSP) BARGES
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| Issued under
the provisions of the Protocol of 1997, as amended, to amend the
International Convention for the Prevention of Pollution from Ships, 1973,
as modified by the Protocol of 1978 relating thereto (hereinafter referred
to as the Convention) under the authority of the Government of:
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|
.
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| (full designation of the country)
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| by...........................................................................................................................
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| (full designation of the competent person or organization
authorized under the provisions of the Convention)
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| Particulars of shipfootnote
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| Name of
ship
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| Distinctive
number or letters
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| IMO
Numberfootnote
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| Port of
registry
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| Gross
tonnage
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| THIS IS
TO CERTIFY THAT:
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| 1 the UNSP
barge has been surveyed in accordance with regulation 3.4 of Annex VI to the
Convention;
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2 the survey
shows that the UNSP barge:
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.1 is not propelled by mechanical means;
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.2 has no system, equipment and/or machinery fitted
that may generate emissions controlled by Annex VI to the
Convention; and
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.3 has neither persons nor living animals on board; and
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| 3 the UNSP
barge is exempted, under regulation 3.4 of Annex VI to the Convention from
the certification and related survey requirements of regulations 5.1 and 6.1
of Annex VI to the Convention.
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| This
Certificate is valid until (dd/mm/yyyy)
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| subject to
the exemption conditions being maintained.
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| Completion
date of the survey on which this Certificate is based (dd/mm/yyyy)
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| Issued
at:
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| (place of issue of the Statement)
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| (dd/mm/yyyy)
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| (date of
issue)
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(signature of duly authorized
official issuing the Statement)
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(seal or stamp of the authority, as appropriate)
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