Appendix Forms of the Document of Compliance, the Safety Management Certificate, the Interim Document of Compliance and the Interim 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 organisation authorised)

Name and address of the company:

…

…

(see paragraph 1.1.2 of the ISM Code)

THIS IS TO CERTIFY THAT the safety management system of the company 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) for the types of ships listed below (delete as appropriate):

• 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 Document of Compliance is valid until ………, subject to periodical verification.

Issued at …

(place of issue of the document)

Date of issue …

…

(Signature of the duly authorised official issuing the document)

(Seal or stamp of issuing authority, as appropriate)

THIS IS TO CERTIFY THAT, at the periodical verification in accordance with Regulation IX/6.1 of the Convention and paragraph 13.4 of the ISM Code, the safety management system was found to comply with the requirements of the ISM Code.

(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 organisation authorised)

Name of ship: …

Distinctive number or letters: …

Port of registry: …

Type of ship^f1: …

Gross tonnage: …

IMO number: …

Name and address of company: …

(see paragraph 1.1.2 of the ISM Code)

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.

Issued at …

(place of issue of the document)

Date of issue …

(Signature of the duly authorised official issuing the certificate)

(Seal or stamp of issuing authority, as appropriate)

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.

(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 organisation authorised)

Name and address of the company: …

(see paragraph 1.1.2 of the ISM Code)

THIS IS TO CERTIFY THAT the safety management system of the company has been recognised as meeting the objectives of paragraph 1.2.3 of the International Management Code for the Safe Operation of Ships and for Pollution Prevention (ISM Code), for the type(s) of ships listed below (delete as appropriate):

• 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 Interim Document of Compliance is valid until:

Issued at: …

(Place of issue of the document)

Date of issue: …

(Signature of the duly authorised official issuing the document)

(Seal or stamp of issuing authority, as appropriate)

(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 organisation authorised)

Name of ship: …

Distinctive number or letters: …

Port of registry: …

Type of ship^f3: …

Gross tonnage: …

IMO number: …

Name and address of company: …

…

(see paragraph 1.1.2 of the ISM Code)

THIS IS TO CERTIFY THAT the requirements of paragraph 14.4 of the ISM Code have been met and that the Document of Compliance/Interim Document of Compliance^f4 of the company is relevant to this ship.

This Interim Safety Management Certificate is valid until …

subject to the Document of Compliance/Interim Document of Compliance remaining valid.

Issued at …

(place of issue of the document)

Date of issue: …

(Signature of the duly authorised official issuing the certificate)

(Seal or stamp of issuing authority, as appropriate)

Certificate No

The validity of this Interim Safety Management Certificate is extended to: …

Date of extension: …

(Signature of the duly authorised official extending the validity)

(Seal or stamp of issuing authority, as appropriate)