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Form A

[Section 29 (4)]

 

Additional Verification in Accordance with Section AI 19.3.7.2 of the ISPS Code

THIS IS TO CERTIFY that at an additional verification required by section 19.3.7.2 of Part A of the ISPS Code the ship was found to comply with the relevant provisions of chapter XI-2 of the Convention and Part A of the ISPS Code.

                                                                   Signed ...........................................................

                                                                    (Signature of authorised official)

                                                                    Place .............................................................

                                                                   Date .................................................................

                                                                 (Seal or stamp of the Authority, as appropriate)

 

 

 

Form B

[Section 29 (4)]

 

 

Additional verification                                 Signed ...........................................................

                                                                      (Signature of authorised official)

                                                                   Place .............................................................

                                                                  Date .................................................................

                                                                 (Seal or stamp of the Authority, as appropriate)

 

 

Additional verification                                  Signed ...........................................................

                                                                               (Signature of authorised official)

                                                                     Place .............................................................

                                                                  Date .................................................................

                                                                 (Seal or stamp of the Authority, as appropriate)

 

 

Additional verification                                  Signed ...........................................................

                                                                      (Signature of authorised official)

                                                                     Place .............................................................

                                                                    Date .................................................................

                                                                   (Seal or stamp of the Authority, as appropriate)

 

 

* This part of the certificate shall be adapted by the Authority to indicate whether it has established additional verifications as provided for in section 19.1.4.