R E P U B L I C O F B U L G A R I A
MINISTRY OF TRANSPORT,
INFORMATION TECHNOLOGY AND COMMUNICATIONS
___________________________________________________________________________________
CARGO SHIP SAFETY RADIO
CERTIFICATE
This Certificate shall be supplemented by a Record of Equipment of Radio Facilities (Form R)
Issued under the provisions of THE INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE
AT SEA, 1974, as amended
under the authority of the Government of the REPUBLIC OF BULGARIA
by the maritime administration of bulgaria
Name of ship
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Distinctive number
or letters /
IMO number*3/
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Port of
Registry
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Gross
Tonnage
(GT)
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Sea areas in which ship is certified to operate (regulation IV/2)
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|
|
|
|
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Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion or an alteration or modification of a major character was commenced…………………………...
THIS IS TO CERTIFY:
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That the ship has been surveyed in accordance with the requirements of regulation I/9 of the Convention.
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That the survey showed that:
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the ship complied with the requirements of the Convention as regards radio installations;
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the functioning of radio installations used in life-saving appliances complied with the requirements of the Convention.
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That an Exemption Certificate has / has not*1/ been issued.
This certificate is valid until:*2 the ______ day of _________________, subject to the periodical surveys in accordance with regulation I/9 of the Convention.
Completion date of survey on which this certificate is based:……………………………………
Issued at ______________________ on the ______ day of __________________
No.
director, maritime
Seal
administration - …………: __________________
(Signature of authorized
official issuing the certificate)
______________________________________________________
* 1/ Delete as appropriate
*2/ Insert the date of expire as specified by the Administration in accordance with regulation I/14(a) of the Convention. The day and month of this date correspond to the anniversary date, as defined in regulation I/2 of the Convention, unless amended in accordance with regulation I/14(h).
*3/ In accordance with the IMO ship identification number scheme, adopted by the Organization by resolution A.600(15).
ENDORSEMENT FOR PERIODICAL SURVEYS
THIS IS TO CERTIFY that, at a survey required by regulation I/9 of the Convention, the ship was found to comply with the relevant requirements of the Convention.
Periodical Survey Place: _______________________ Date: __________________
Seal maritime
administration: ____________________
(Signature of authorized official)
____________________________________________________________________________
Periodical Survey Place: _______________________ Date: _______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
____________________________________________________________________________
Periodical Survey Place: _______________________ Date: ______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
____________________________________________________________________________
Periodical Survey Place: _______________________ Date: _______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
Periodical Survey in accordance with Regulation I/14(h)(iii)
THIS IS TO CERTIFY that, at a periodical survey in accordance with regulation I/14(h)(iii) of
the Convention, the ship was found to comply with the relevant requirements of the Convention.
Place: _______________________ Date: ________________________
Seal maritime
administration: ____________________
(Signature of authorized official)
Endorsement to extend the certificate if valid for less than 5 years where regulation I/14(c) applies.
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(c) of the Convention, be accepted as valid until: ________________
Place: _______________________ Date: _____________________
Seal maritime
administration: ____________________
(Signature of authorized official)
Endorsement where the renewal survey has been completed and regulation I/14(d) applies.
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with regulation I/14(d) of the Convention, be accepted as valid until: _______________
Place: _________________ Date: ______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
Endorsement to extend the validity of the certificate until reaching the port of survey or for period of grace where regulation I/14(e) or I/14(f) applies.
This certificate shall, in accordance with regulation I/14(e) / I/14(f)*1/ of the Convention, be accepted as valid until: ________________
Place: _________________ Date: ______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
Endorsement for advancement of anniversary date where regulation I/14(h) applies.
In accordance with regulation I/14(h) of the Convention, the new anniversary date is: ____________
Place: __________________ Date: _____________________
Seal maritime
administration: ____________________
(Signature of authorized official)
In accordance with regulation I/14(h) of the Convention, the new anniversary date is: ____________
Place: ________________ Date: ______________________
Seal maritime
administration: ____________________
(Signature of authorized official)
*1/ Delete as appropriate
Приложение № 17а към чл. 29, ал. 4
RECORD OF EQUIPMENT FOR CARGO SHIP SAFETY RADIO (FORM R)
Record of Equipment for compliance with THE INTERNATIONAL CONVENTION FOR SAFETY OF LIFE AT SEA, 1974, as amended
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PARTICULARS OF SHIP:
Name of ship ……………………….……….
Distinctive number or letters .……………………………….
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