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[Section 35 (2)]

                                           Form of the Interim International Ship Security Certificate

 

 (Official seal)

Certificate No.                                                                                   (State)

 

 

                                          Issued under the provisions of the

INTERNATIONAL SHIP AND PORT FACILITY SECURITY CODE (ISPS CODE)  

 

Under the authority of the Government of .........................................................................

                                                                                         (name of State)

By........................................................................................................................................

                                                 (Persons or organisation authorised)

 

Name of Ship:

Distinctive number or letters:......................................................................................

Port of registry: ...............................................................................................................

Type of ship: ..............................................................................................................

Gross tonnage:.................................................................................................................

IMO Number: ............................................................................................................

Name and address of company: .......................................................................................

 

Is this a subsequent, consecutive interim certificate? Yes/No*

If Yes, date of issue of initial interim certificate .........................................................

THIS IS TO CERTIFY THAT the requirements of section N19.4.2 of the ISPS Code have been complied with.

This Certificate is issued pursuant to section N19.4 of the ISPS Code.

This Certificate is valid until .......................................................................................

Issued at...................................................................................................................

                                           (Place of issue of the certificate)

 

Date of issue...................................................................................................................................

                        (Signature of the duly authorised official issuing the Certificate)

                          (Seal or stamp of issuing Authority, as appropriate)