INTERNATIONAL SEWAGE POLLUTION PREVENTION EXEMPTION CERTIFICATE FOR
UNMANNED NON-SELF-PROPELLED (UNSP) BARGES
Issued under the provisions of the International Convention for the
Prevention of Pollution from Ships, 1973, as modified by the Protocol of 1978, as
amended, relating thereto (hereinafter referred to as "the
Convention") under the authority of the Government of:
|
|
| (full designation
of the country)
|
| by
|
| (full designation
of the competent person or organization authorized under the
provisions of the Convention)
|
| Particulars of shipfootnote
|
| Name of ship
|
| Distinctive number or
letters
..
|
| Port of registry
|
| Gross tonnage
..
|
THIS IS TO CERTIFY:
1 That the unmanned non-self-propelled (UNSP) barge has been surveyed in
accordance with regulation 3.2 of Annex
IV to the Convention;
2 That the survey shows that the unmanned non-self-propelled (UNSP)
barge:
-
.1 is not propelled by mechanical means;
.2 has neither persons nor living animals on board;
.3 is not used for holding sewage during transport; and
.4 has no arrangements that could produce sewage as defined in
regulation 1.3 of Annex IV to the Convention; and
3 That the UNSP barge is exempted, under regulation 3.2 of Annex
IV to the Convention, from the certification and related survey requirements
of regulations 4.1 and 5.1 of Annex
IV to the Convention.
This certificate is valid until (dd/mm/yyyy)
.
subject to the exemption conditions being maintained.
Completion date of the survey on which this certificate is based
(dd/mm/yyyy)
.
| Issued at
|
| (place of issue of
certificate)
|
|
| ....................................................
|
....................................................
|
| (date of issue)
(dd/mm/yyyy)
|
(signature of
duly authorized official issuing the certificate)
|
|
|
|
| (seal or stamp of the authority, as
appropriate)
|