Appendix 3 - Form of International Pollution Prevention Certificate for the Carriage of Noxious Liquid Substances in Bulk footnote
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Statutory Documents - IMO Publications and Documents - International Conventions - MARPOL - International Convention for the Prevention of Pollution from Ships - Annex II of MARPOL 73/78Regulations for the Control of Pollution by Noxious Liquid Substances in Bulk - Appendix 3 - Form of International Pollution Prevention Certificate for the Carriage of Noxious Liquid Substances in Bulk1

Appendix 3 - Form of International Pollution Prevention Certificate for the Carriage of Noxious Liquid Substances in Bulk footnote

INTERNATIONAL POLLUTION PREVENTION CERTIFICATE FOR
THE CARRIAGE OF NOXIOUS LIQUID SUBSTANCES IN BULK
Issued under the provisions of the International Convention for the Prevention of Pollution from Ships, 1973, as modified by the Protocol of 1978 relating thereto, as amended (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 ship footnote
Name of ship ........................................................................................................................
Distinctive number or letters ................................................................................................
IMO Number .........................................................................................................................
Port of registry .....................................................................................................................
Gross tonnage .....................................................................................................................






THIS IS TO CERTIFY:
1 That the ship has been surveyed in accordance with regulation 8 of Annex II of the Convention.
2 That the survey showed that the structure, equipment, systems, fitting, arrangements and material of the ship and the condition thereof are in all respects satisfactory and that the ship complies with the applicable requirements of Annex II of the Convention.
3 That the ship has been provided with a Procedures and Arrangements Manual as required by regulation 14 of Annex II of the Convention, and that the arrangements and equipment of the ship prescribed in the Manual are in all respects satisfactory
4 That the ship complies with the requirements of Annex II to MARPOL 73/78 for the carriage in bulk of the following Noxious Liquid Substances, provided that all relevant provisions of Annex II are observed.
Noxious Liquid Substances Conditions of carriage
(tank numbers etc.) 		Pollution Category
     
     
     
     
     
Continued on additional signed and dated sheets
This certificate is valid until ............... subject to surveys in accordance with regulation 8 of Annex II of the Convention.
Completion date of the survey on which this certificate is based (dd/mm/yyyy): ...............................
Issued at ..............................................................................................................................................
(Place of issue of certificate)
       
............................... .................................................................................................
(Date of issue) (Signature of authorized official issuing the certificate)




     
(Seal or stamp of the authority, as appropriate)
ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS
THIS IS TO CERTIFY that, at a survey required by regulation 8 of Annex II of the Convention, the ship was found to comply with the relevant provisions of the Convention:
Annual survey: Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
Annual/Intermediatefootnote survey: Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
Annual survey: Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
ANNUAL/INTERMEDIATE SURVEY IN ACCORDANCE WITH REGULATION 10.8.3
THIS IS TO CERTIFY that, at an annual/intermediatefootnote survey in accordance with regulation 10.8.3 of Annex II of the Convention, the ship was found to comply with the relevant provisions of the Convention:
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR LESS THAN 5 YEARS WHERE REGULATION 10.3 APPLIES
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation 10.3 of Annex II of the Convention, be accepted as valid until
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN COMPLETED AND REGULATION 10.4 APPLIES
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with regulation 10.4 of Annex II of the Convention, be accepted as valid until
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL REACHING THE PORT OF SURVEY OR FOR A PERIOD OF GRACE WHERE REGULATION 10.5 OR 10.6 APPLIES
This Certificate shall, in accordance with regulation 10.5 or 10.6 of Annex II of the Convention, be accepted as valid until ................................................................................
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE REGULATION 10.8 APPLIES
In accordance with regulation 10.8 of Annex II of the Convention, the new anniversary date is ..................................................................................................................................
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
   
In accordance with regulation 10.8 of Annex II of the Convention, the new anniversary date is ..................................................................................................................................
  Signed ........................................................
  (Signature of authorized official)
  Place ..........................................................
  Date ... dd/mm/yyyy ...................................
(Seal or stamp of the authority, as appropriate)
Parent topic: Annex II of MARPOL 73/78Regulations for the Control of Pollution by Noxious Liquid Substances in Bulk
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