THIS IS TO CERTIFY that at a survey required by regulation 5 of Annex VI of the Convention the ship
was found to comply with the relevant provisions of the Convention:
Annual*/lntermediate* survey:
Signed.
(Signature of duly authorized official)
Place.
Date.
(Seal or stamp of the authority, as appropriate)
Annual*/lntermediate* survey:
Signed.
(Signature of duly authorized official)
Place.
Date.
(Seal or stamp of the authority, as appropriate)
Annual/Intermediate survey:
Signed.
(Signature of duly authorized official)
Place
Date
(Seal or stamp of the authority, as appropriate)
Annual survey:
Signed.
(Signature of duly authorized official)
Place.
Date.
(Seal or stamp of the authority, as appropriate)
Delete as appropriate
MEPC 39/6
ANNEX I
Page 20
Supplement to International Air Pollution Prevention Certificate
(IAPP Certificate)
RECORD OF CONSTRUCTION AND EQUIPMENT
In respect of the provisions of Annex VI of the International Convention for the Prevention of Pollution from Ships, 1973, as modified by the Protocols of 1978 and 1997 relating thereto (hereinafter referred to as "the Convention").
Notes:
1 This Record shall be permanently attached to the IAPP Certificate. The IAPP Certificate shall be available on board the ship at all times.
2 If the language of the original Record is neither English nor French, the text shall include a translation into one of these languages.
3 Entries in boxes shall be made by inserting either a cross (x) for the answer "yes" and "applicable" or a (-) for the answers "no" and "not applicable" as appropriate.
4 Unless otherwise stated, regulations mentioned in this Record refer to regulations of Annex VI of the Convention and resolutions or circulars refer so those adopted by the International Maritime Organization.
1 Particulars of ship
1.1 Name of ship.
1.2 Distinctive number or letters.
1.3 IMO number.
1.4 Port of registry.
1.5 Gross tonnage.
1.6 Total installed power (kW).
1.7 Date of Construction:
1.7.1 Date of building contract.
1.7.2 Date on which keel wan laid or ship was at a similar stage of construction.
