mezhdunarodnoe-svidetelstvo-ob-izyatii-dlya-gruzovoy-marki
Международная конвенция от 05.04.1966, в которой приведена данная форма, вступила в силу для СССР 22 июля 1968 года.
Annex III
INTERNATIONAL LOAD LINE EXEMPTION CERTIFICATE
(Official seal)
Issued under the provisions of the International Convention on
Load lines, 1966, under the authority of the Government of
______________________________________________________________________
(full official designation of the country)
by____________________________________________________________________
(full official designation of the competent person or organization
duly authorized
______________________________________________________________________
under the provisions of the International Convention on
Load Lines, 1966)
Name of Ship
|
Distinctive Number or
Letters
|
Port of
Registry
|
|
|
|
This is to certify that the above-mentioned ship is exempted from
the provisions of the 1966 Convention, under the authority conferred
by Article 6 (2) Article 6 (4) <*> of the Convention referred to
above.
The provisions of the Convention from which the ship is exempted
under Article 6 (2) are:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
The voyage for which exemption is granted under Article 6 (4)
is:
From: ________________________________________________________________
To: __________________________________________________________________
Conditions, if any, on which the exemption is granted under
either Article 6 (2) or Article 6 (4):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
--------------------------------
<*> Delete whichever is inapplicable.
This certificate is valid until _____________________________
subject, where appropriate, to periodical inspections in accordance
with Article 14 (1) (с) of the Convention.
Issued at ____________________________________________________________
(Place of issue of certificate)
____________19___
(Date of issue)
_______________________________________________
(Signature of official issuing the certificate)
and/or
(Seal of issuing authority)
If signed, the following paragraph is to be added:
The undersigned declares that he is duly authorized by the said
Government to issue this certificate.
_______________________
(Signature)
Reverse of Certificate
This is to certify that this ship continues to comply with the
conditions under which this exemption was granted.
Place ______________________________ Date _______________________
Signature and/or Seal of issuing authority.
Place ______________________________ Date _______________________
Signature and/or Seal of issuing authority.
Place ______________________________ Date _______________________
Signature and/or Seal of issuing authority.
Place ______________________________ Date _______________________
Signature and/or Seal of issuing authority.
This ship continues to comply with the conditions under which
this exemption was granted and the validity of this certificate is, in
accordance with Article 19 (2) (a) of the Convention, extended until
_____________________
Place ______________________________ Date _______________________
Signature and/or Seal of issuing authority.