SAFETY MANAGEMENT CERTIFICATE
(Official seal) (State) Certificate No.
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 ____________________________________ (name of the State) by __________________________________________________________________
(person or organization authorized) Name of ship: .................................... Distinctive number or letters: .................................... Port of registry: .................................... Type of ship* ................................... Gross tonnage: .................................... IMO Number: .................................... Name and address of Company: .................................... Company identification number …................................. ...................................... _______
* Insert the type of ship from among the following: passenger ship, passenger high-speed craft, cargo high-speed craft, bulk carrier, oil tanker, chemical tanker, gas carrier, mobile offshore drilling unit, other cargo ship.
THIS IS TO CERTIFY THAT the safety management system of the ship has been audited and that it complies with the requirements of the International Management Code for the Safe Operation of Ships and for Pollution Prevention (ISM Code), following verification that the Document of Compliance for the Company is applicable to this type of ship.
This Safety Management Certificate is valid until
…………….........., subject to periodical verification and the Document of Compliance remaining valid.
Completion date of the verification on which this certificate is based: ……..................
(dd/mm/yyyy) Issued at ......................................
(place of issue of the document)
Date of issue ………………….. ....................................
(Signature of the duly authorized official issuing the document)
(Seal or stamp of issuing authority, as appropriate) * * * Certificate No.
ENDORSEMENT FOR INTERMEDIATE VERIFICATION AND ADDITIONAL VERIFICATION (IF REQUIRED)
THIS IS TO CERTIFY THAT, at the periodical verification in accordance with regulation IX/6.1 of the Convention and paragraph 13.8 of the ISM Code, the safety management system was found to comply with the requirements of the ISM Code.
INTERMEDIATE VERIFICATION
(to be completed between the
second and third anniversary
date)
Signed: ................................ (Signature of authorized official) Place: ................................. Date: ..................................
_____________________________________________________________________
ADDITIONAL VERIFICATION* Signed: ................................ (Signature of authorized official) Place: ................................. Date: .................................. ADDITIONAL VERIFICATION* Signed: ................................ (Signature of authorized official) Place: ................................. Date: .................................. ADDITIONAL VERIFICATION* Signed: ................................ (Signature of authorized official) Place: ................................. Date: .................................. ________________
* If applicable. Reference is made to the relevant provisions of section 3.2 "Initial verification" the Revised Guidelines on implementation of the International Safety Management (ISM) Code by Administrations adopted by the Organization by resolution A.1022(26).
* * * Certificate No. ENDORSEMENT WHERE THE RENEWAL VERIFICATION HAS BEEN COMPLETED AND PART B 13.13 OF THE ISM CODE APPLIES The ship complies with the relevant provisions of part B of the ISM Code, and the Certificate should, in accordance with part B 13.13 of the ISM Code, 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 VERIFICATION WHERE PART B 13.12 OF THE ISM CODE APPLIES OR FOR A PERIOD OF GRACE WHERE PART B 13.14 OF THE ISM CODE APPLIES This Certificate should, in accordance with part B 13.12 or part B 13.14 of the ISM Code, be accepted as valid until …………………
Signed ..................................... (Signature of authorized official) Place ....................................... Date ........................................ (Seal or stamp of the authority, as appropriate)
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