Appendix 2 - Model form of Certificate of Fitness
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - Resolutions - Assembly - IMO Resolution A.673(16) – Guidelines for the Transport and Handling of Limited Amounts of Hazardous and Noxious Liquid Substances in Bulk on Offshore Support Vessels – (Adopted on 19 October 1989) - Annex - Guidelines for the Transport and Handling of Limited Amounts of Hazardous and Noxious Liquid Substances in Bulk on Offshore Support Vessels - Appendix 2 - Model form of Certificate of Fitness

Appendix 2 - Model form of Certificate of Fitness

CERTIFICATE OF FITNESS
(Official seal)
Issued under the provisions of the
GUIDELINES FOR THE TRANSPORT AND HANDLING OF LIMITED AMOUNTS OF HAZARDOUS AND NOXIOUS LIQUID SUBSTANCES IN BULK ON OFFSHORE SUPPORT VESSELS (resolution A.673(16), as amended by resolutions MSC.236(82) and MEPC.158(55))
under the authority of the Government of
..........................................................................................................................
(full official designation of country)
by ..........................................................................................................................
(full official designation of the competent person
or organization recognized by the Administration)
Particulars of ship footnote        
           
Name of ship        
Distinctive number or letters        
IMO Numberfootnote        
Port of Registry        
Gross tonnage        
Date on which keel was laid or on which the vessel was at a similar stage of construction or (in the case of a converted vessel) date on which conversion for the carriage of bulk liquids subject to these Guidelines was commenced: ...................................................................
 
The ship also complies fully with the following amendments to the Guidelines:
..............................................................................................................................................
..............................................................................................................................................
The ship is exempted from compliance with the following provisions of the Guidelines:
..............................................................................................................................................
..............................................................................................................................................
           
THIS IS TO CERTIFY:
1 That the ship has been surveyed in accordance with the provisions of 1.5 of the Guidelines.
2That the survey showed that the construction and equipment of the ship:
  1. complied with the relevant provisions of the Guidelines applicable to "new" shipsfootnote;
  2. complied with the provisions of the Guidelines in respect of "existing" shipsfootnote.

3That the ship has been provided with a Manual in accordance with Appendix 4 of Annex II of MARPOL 73/78 as called for by regulation 14 of Annex II and that the arrangements and equipment of the vessel prescribed in the manual are in all respects satisfactory.

4That the ship complies with the requirements of the Guidelines and Annex II to MARPOL 73/78 for carriage in bulk of the following products provided that all relevant operational provisions of the Guidelines and Annex II are observed:

Products

(refer to Notes 1, 2 on completion of Certificate)

Conditions of carriage

(tank numbers, etc.)

Pollution Category
     
     
     
     
     
     
     
     
* Continued on attachment 1, additional signed and dated sheetsfootnote.

Tank numbers referred to in this list are identified on attachment 2, showing a signed and dated simplified tank plan.

5That, in accordance with 1.4footnote of the Guidelines and 2.8.2footnote of the IBC Code, the provisions of the Guidelines and the Code are modified in respect of the vessel in the following manner:

..............................................................................................................................................
6 That the ship must be loaded:
  1. in accordance with the loading conditions provided in the approved loading manual, stamped and dated ................. and signed by a responsible officer of the Administration, or of an organization recognized by the Administrationfootnote;
  2. in accordance with the loading limitations appended to this Certificatefootnote.

Where it is required to load the ship other than in accordance with the above instructions, then the necessary calculations to justify the proposed loading conditions should be communicated to the certifying Administration who may authorize in writing the adoption of the proposed loading condition.footnote

This certificate is valid until .................................................................................................. footnote
    (dd/mm/yyyy)    
subject to surveys in accordance with 1.5 of the Guidelines.
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)    
Notes on completion of Certificate:
  1. Products: products listed in appendix 1 to the Guidelines or which have been evaluated by the Administration in accordance with 1.2.4 of the Guidelines should be listed. In respect of the latter "new" products, any special requirements provisionally prescribed should be noted.
  2. Products: The list of products the vessel is suitable to carry should include the Noxious Liquid Substances of category Z which are not covered by the Guidelines and should be identified as "IBC Code chapter 18 category Z".
ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS
THIS IS TO CERTIFY that at a survey required by 1.5.2 of the Code the ship was found to comply with the relevant provisions of the Guidelines.
Annual survey: Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
Annual survey: Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
ANNUAL/INTERMEDIATE SURVEY IN ACCORDANCE WITH PARAGRAPH 1.5.6.8.3
THIS IS TO CERTIFY that, at an annual/intermediatefootnote survey in accordance with paragraph 1.5.8.6.3 of the Code, the ship was found to comply with the relevant provisions of the Guidelines:
  Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR LESS THAN 5 YEARS WHERE PARAGRAPH 1.5.6.3 APPLIES
The ship complies with the relevant provisions of the Guidelines, and this Certificate shall, in accordance with paragraph 1.5.6.3 of the Code, be accepted as valid until:
.......................................................  
(dd/mm/yyyy)  
  Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN COMPLETED AND PARAGRAPH 1.5.6.4 APPLIES
The ship complies with the relevant provisions of the Guidelines, and this Certificate shall, in accordance with paragraph 1.5.6.4 of the Code, be accepted as valid until:
.......................................................  
(dd/mm/yyyy)  
  Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(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 PARAGRAPH 1.5.6.5 OR 1.5.66 APPLIES
   
This Certificate shall, in accordance with paragraph 1.5.6.5/1.5.6.6footnote of the Code, be accepted as valid until .......................................................
  Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE PARAGRAPH 1.5.6.8 APPLIES
In accordance with paragraph 1.5.6.8 of the Code, the new anniversary date is .......................................................
  Signed: .......................................................
  (Signature of duly authorized official)
  Place: .........................................................
  Date: ..........................................................
  (dd/mm/yyyy)
(Seal or stamp of the Authority, as appropriate)
   
   
   
   
ATTACHMENT 1 TO THE CERTIFICATE OF FITNESS
  Continued list of products to those specified in section 3, and their conditions of carriage.    
  Products
(refer to Notes 1, 2 on
completion of Certificate) 		Conditions of carriage
(tank numbers etc.) 		Pollution
Category 		 
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
  Date ....................................................................... ..................................................................................    
  (dd/mm/yyyy) (Signature of official issuing the Certificate and/or seal of issuing authority)    
  (as for Certificate)  
ATTACHMENT 2 TO THE CERTIFICATE OF FITNESS
TANK PLAN (specimen)
   
Name of ship: ...................................................................................................................
Distinctive number or letters: ...............................................................................................
   
Date ................................................. .................................................
(dd/mm/yyyy) (Signature of official issuing the Certificate and/or seal of issuing authority)
(as for Certificate)
Parent topic: Annex - Guidelines for the Transport and Handling of Limited Amounts of Hazardous and Noxious Liquid Substances in Bulk on Offshore Support Vessels
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