Endorsement to extend the Certificate if valid for less than 5 years where regulation 10(3) applies

Endorsement where the renewal survey has been completed and regulation 10(4) applies

The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation 10(4) of Annex I of the Convention, be accepted as valid until ____________

Place: _____________________ Date: _________________

Seal MARITIME

ADMINISTRATION: ___________________

(Signature of authorized official)

THAN Endorsement to extend the validity of the Certificate until reaching the port of survey or for a period of grace where regulation 10(5) or 10(6) applies

Place: _____________________ Date: ____________________

Seal MARITIME

ADMINISTRATION: ___________________

(Signature of authorized official)

Endorsement for advancement of anniversary date where regulation 10(8) applies

In accordance with regulation 10(8) of Annex I of the Convention, the new anniversary date is: __________________

Place: _____________________ Date: _____________________

Seal MARITIME

ADMINISTRATION: ___________________

(Signature of authorized official)

In accordance with regulation 10(8) of Annex I of the Convention, the new anniversary date is: __________________

Place: _____________________ Date: ______________________

Seal MARITIME

ADMINISTRATION: ___________________

(Signature of authorized official)

*1/ For oil tankers

*2/ Delete as appropriate


Приложение № 22а към чл. 34, ал. 5
FORM A

Supplement to the International Oil Pollution Prevention Certificate

OTHER THAN OIL TANKERS

in respect of the provisions of Annex I of 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”).

Notes

1.	This form is to be used for the third type of ships as categorized in the IOPP Certificate, i.e. “ship other than any of the above”. For oil tankers and ships other then oil tankers with cargo tanks coming under regulation 2.2 of Annex I of the Convention, Form B shall be used.
2.	This Record shall be permanently attached to the IOPP Certificate. The IOPP Certificate shall be available on board the ship at all times.
3.	The language of the original Record shell be at least in English, French or Spanish. If an official language of the issuing country is also used, this shall prevail in case of a dispute or discrepancy.
4.	Entries in boxes shall be made by inserting either a cross (x) for the answers “yes” and “applicable” or a dash (-) for the answers “no” and “not applicable” as appropriate.
5.	Regulations mentioned in this Record refer to regulations of Annex I of the Convention and resolutions refer to those adopted by the International Maritime Organisation.

1.	Particulars of ship
1.1	Name of ship
1.2	Distinctive number or letters
1.3	Port of registry
1.4	Gross tonnage
1.5	Date of build
1.5.1	Date of building contract
1.5.2	Date on which keel was laid or ship was at similar
	stage of construction
1.5.3	Date of delivery
1.6	Major conversion (if applicable):
1.6.1	Date of conversion contract
1.6.2	Date on which conversion was commenced
1.6.3	Date of completion of conversion
1.7	The ship has been accepted by the Administration as a
	“ship delivered on or before 31 December 1979” under
	regulation 1.28.1 due to unforeseen delay in delivery
2.	Equipment for the control of oil discharge from machinery space bilges and oil fuel tanks (regulations 16 and 14)
2.1	Carriage of ballast water in oil fuel tanks:
2.1.1	The ship may under normal conditions carry ballast
	water in oil fuel tanks
2.2	Type of oil filtering equipment fitted:
2.2.1	Oil filtering (15 ppm) equipment (regulation 14.6)
2.2.2	Oil filtering (15 ppm) equipment with alarm and automatic
	stopping device (regulation 14.7)
2.3	Approval standards:*
2.3.1	The separating / filtering equipment:
2.3.1.1	has been approved in accordance with resolution A.393(X)
2.3.1.2	has been approved in accordance with resolution MEPC.60(33)
2.3.1.3	has been approved in accordance with resolution MEPC.107(49)
2.3.1.4	has been approved in accordance with resolution A.233(VII)
2.3.1.5	has been approved in accordance with national standards
	not based upon resolution A.393(X) or A.233(VII)
2.3.1.6	has not been approved
2.3.2	The process unit has been approved in accordance
	with resolution A.444(XI)
2.3.3	The oil content meter:
2.3.3.1.	has been approved in accordance with resolution A.393(X)
2.3.3.2.	has been approved in accordance with resolution MEPC.60(33)
2.3.3.3	has been approved in accordance with resolution MEPC.107(49)
2.4	Maximum throughput of the system is:			………………………… m3/h.
2.5	Waiver of regulation 14:
2.5.1	The requirements of regulation 14.1 or 14.2 are waived in respect of the ship in accordance with regulation 14.5.
2.5.1.1	The ship is engaged exclusively on voyages within special area(s):
2.5.1.2	The ship is certified under the international Code of Safety for High-Speed
	Craft and engaged on a scheduled service with a turn-around time not
	exceeding 24 hours.
2.5.2	The ship is fitted with holding tank(s) for the total retention on board of
	all oily bilge water as follows :
Tank Identification			Tank Location
			Frames: (from) - (to)