FSU16

Form of Safety Certificate For Cargo Ships

This Certificate shall be supplemented by a Record of Equipment of Radio Facilities (Form C)

(FIJI seal)

Issued under the provisions of the

INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, as modified by the Protocol of 1988 relating thereto

Under the authority of the Government of

FIJI

By

________________

(signature of Chief Executive Officer MSAF or authorised person)

Particulars of ship²⁸.

Name of Ship .................................................................................

Distinctive number or letters .................................................................................

Port of registry .................................................................................

Gross Tonnage .................................................................................

Deadweight of ship (metric tons)²⁹.................................................................................

Length of ship (regulation III/3.12 .................................................................................

Sea areas in which ship is certified to operate (regulation IV/2) .................................................................................

IMO Number³⁰.................................................................................

Type of ship³¹

• Bulk carrier
• Oil tanker
• Chemical tanker
• Gas carrier
• Cargo ship other than any of the above

Date of Build:

• Date of building contract .................................................................................
• Date on which keel was laid or ship was at similar stage of construction .................................................................................
• Date of delivery .................................................................................
• Date on which work for a conversion or an alternation or modification of a major character was commenced (where applicable) .................................................................................
• All applicable dates shall be completed.

THIS IS TO CERTIFY:

• 1.That the ship has been surveyed in accordance with the requirements of regulation I/8, I/9 and I/10 of the Convention.
• 2.That the survey showed that:
  • 2.1the condition of the structure, machinery and equipment as defined in regulation I/10 was satisfactory and the ship complied with the relevant requirements of Chapter II-1 and Chapter II-2 of the Convention (other than those relating to fire safety systems and appliances and fire control plans);
  • 2.2the last 2 inspections of the outside of the ship’s bottom took place on ................. and .................

    (dates)

  • 2.3the ship complied with the requirements of the Convention as regards fire safety systems and appliances and fire control plans;
  • 2.4the lifesaving appliances and the lifesaving equipment of the lifeboats, liferafts and rescue boats were provided in accordance with the requirements of the Convention;
  • 2.5the ship was provided with a line-throwing appliance and radio installations used in lifesaving appliances in accordance with the requirements of the Convention;
  • 2.6the ship complied with the requirements of the Convention as regards radio installations;
  • 2.7the functioning of the radio installations used in lifesaving appliances complied with the requirements of the Convention;
  • 2.8the ship complied with the requirements of the Convention as regards shipborne navigational equipment, means of embarkation for pilots and nautical publications;
  • 2.9the ship was provided with lights, shapes, means of making sound signals and distress signals in accordance with the requirements of the Convention and the International Regulation for Preventing Collisions at Sea in force;
  • 2.10in all other respects the ship complied with the relevant requirements of the Convention;
  • 2.11the ship was/was not³² subjected to an alternative design and arrangements in pursuance of regulation II-2/17 of the Convention;
  • 2.12a Document of approval of alternative design and arrangements for fire safety is /is not³⁷ appended to this Certificate.
• 3.That an Exemption Certificate has/has not³⁷ been issued.

This certificate is valid until .................³³ subject to the annual, intermediate and periodical surveys and inspections of the outside of the ship’s bottom in accordance with regulation I/8, I/9 and I/10 of the convention.

Issued at .................................................................................

(Place of issue of certificate)

Completion date of the survey on which this certificate is based:

................................................................................. (dd/mm/yyyy)

(MSAF seal or authorised organisation seal)

Endorsement for annual and intermediate surveys relating to structure, machinery and equipment referred to in paragraph 2.1 of this certificate.

THIS IS TO CERTIFY that, at a survey required by regulation I/10 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

Annual/Periodical³⁴ survey

Signed:..................

(Signature of Chief Executive Officer MSAF or authorised person)

Place:..................

Date:..................

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

Annual/intermediate survey in accordance with regulation 1/14(h)(iii)

THIS IS TO CERTIFY that, after an annual/intermediate³⁵ survey in accordance with regulation I/10 and 1/14(h)(iii) of the Convention, this ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

Endorsement for inspections of the outide of the ship’s bottom ³⁵

THIS IS TO CERTIFY that, at an inspection required by regulation I/10 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

Endorsement for annual and periodical surveys relating to life saving appliances and other equipment referred to in paragraph 2.3, 2.4, 2.5, 2.8, 2.9 of this certificate.

THIS IS TO CERTIFY that, at a survey required by regulation I/8 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

Annual/Periodical³⁶ survey

Signed:..................

(Signature of Chief Executive Officer MSAF or authorised person)

Place:..................

Date:..................

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

Annual/periodical survey in accordance with regulation 1/14(h)(iii)

THIS IS TO CERTIFY that, after an annual/periodical³⁶ survey in accordance with regulation I/8 and 1/14(h)(iii) of the Convention this ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

Endorsement periodical surveys relating to radio installations referred to in paragraph 2.6 and 2.7 of this certificate.

THIS IS TO CERTIFY that, after a survey required by regulation I/9 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

(MSAF seal or authorised organisation seal)

Periodical survey in accordance with regulation 1/14(h)(iii)

THIS IS TO CERTIFY that, a periodic survey in accordance with regulation I/9 and 1/14(h) (iii) of the Convention this ship was found to comply with the relevant requirements of the Convention.

Signed: .................................................................................

(MSAF seal or authorised organisation seal)

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 1/14(c) of the Convention be accepted as valid until .................

(MSAF seal or authorised organisation seal)

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 1/14(d) of the Convention be accepted as valid until .................

(MSAF seal or authorised organisation seal)

Endorsement to extend the validity of the certificate until reaching the port of survey or for the period of grace where regulation I/14(e) or I/14(f) applies

The ship complies with the relevant requirements of the Convention, and this Certificate shall, in accordance with regulation 1/14(e)/I/14(f)³⁷ of the Convention be accepted as valid until ..................................

(MSAF seal or authorised organisation seal)

Endorsement for advancement of anniversary date where regulation I/14(h) applies

The ship complies with the relevant requirements of the Convention, and this Certificate shall, in accordance with regulation 1/14(h) of the Convention be accepted as valid until .................................................................................

(MSAF seal or authorised organisation seal)

In accordance with regulation I/14(h) of the Convention, the new anniversary date is .................................................................................

(MSAF seal or authorised organisation seal)

1. Particulars of ship

Name of ship ................................................................

Distinctive number or letters ................................................................

Minimum number of persons with required qualifications to operate the radio installations ................................................................

2. Details of life-saving appliances

3 Details of radio facilities

4 Methods used to ensure availability of radio facilities (regulation IV/15.6 and 15.7)

4.1 Duplicate of equipment ................................................................

4.2 Shore-based maintenance ................................................................

4.3 At-sea maintenance capability ................................................................

5. Details of navigational systems and equipment

THIS IS TO CERTIFY that this Record is correct in all respects.

Issued at.................................................................................

(Place of issue of the record)

...................................................

(Date of issue) (Signature of Chief Executive Officer MSAF or

authorised person)

(MSAF seal or authorised organisation seal)