Page 287 - Rules of Navigation2020

DECLARATION “II”
SHIPS SAFETY DECLARATION

Date : …………………..

Master: …………....……..

Vessel’s Name : ………………………………………

Registry : ………………………………………

Vessel’s Owner : ………………………………………
Address : ………………………………………

Vessel’s Operator : ………………………………………

Address : ………………………………………

Agent : ………………………………………

ISSUING ISSUE EXIPARTION
DOCUMENT
AGENCY DATE DATE

IMO Certificate

Classification Society Certification
(1)

Safety Equipment Certificate

Safety Construction Certificate

Safety Radio Telegraph Certificate

Other Safety Inspections
(2)

Master’s Signature : ………………..

1 ) Issued from one of IACS and still under its supervision.
2 ) Including ISM requirement.

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