INTERNATIONAL OIL 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:
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| (full
designation of the country)
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| by
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designation of the competent person or organization authorized under
the provisions of the Convention)
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| Particulars of shipfootnote
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| Name of ship
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| Distinctive number or
letters
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| Port of registry
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| Gross tonnage
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THIS IS TO CERTIFY:
1 That the UNSP barge has been surveyed in accordance with regulation 3.7
of Annex
I to the Convention;
2 That the survey shows that the UNSP barge:
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.1 is not propelled by mechanical means;
.2 carries no oil (as defined in regulation 1.1 of Annex
I to the Convention);
.3 has no machinery fitted that may use oil or generate oil residue
(sludge);
.4 has no oil fuel tank, lubricating oil tank, oily bilge water
holding tank and oil residue (sludge) tank; and
.5 has neither persons nor living animals on board; and
3 That the UNSP barge is exempted, under regulation 3.7 of Annex
I to the Convention, from the certification and related survey requirements of
regulations 6.1 and 7.1 of Annex
I 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)
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| (place of issue of certificate)
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....................................................
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| (date of issue)
(dd/mm/yyyy)
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(signature of
duly authorized official issuing the certificate)
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| (seal or stamp of the authority, as
appropriate)
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