International Sewage Pollution Prevention Certificate
                                    
                                    Issued under the provisions of the International Convention for the Prevention of
                                       Pollution from Ships, 1973, as modified by the Protocol of 1978 relating thereto,
                                       and as amended by resolution MEPC. 115(51), (hereinafter referred to as “the Convention”)
                                       under the authority of the Government of:
                                    
                                    ....................................................................................................................
                                    
                                     (full designation of the country) 
                                    
                                    by ...............................................................................................................
                                       
                                    
                                    (full designation of the competent person or organization authorized under the provisions
                                       of the Convention) 
                                    
                                    
                                       Particulars of ship
                                       
                                       
                                    
                                    Name of ship ................................................................................................
                                    
                                    Distinctive number or letters ...........................................................................
                                    
                                    Port of registry ..............................................................................................
                                    
                                    Gross tonnage ..............................................................................................
                                    
                                    Number of persons which the ship is certified to carry .......................................
                                    
                                    IMO Number .......................................................................................
                                    
                                    New/existing ship .......................................................................................
                                    
                                    Date on which keel was laid or ship was at a similar stage of construction or, where
                                       applicable, date on which work for a conversion or an alteration or modification of
                                       a major character was commenced ..............
                                    
                                    THIS IS TO CERTIFY
                                    
                                    
                                       - 
                                          1. That the ship is equipped with a sewage treatment plant/comminuter/holding tank and a discharge pipeline in compliance with regulations 9 and 10 of Annex IV of the
                                             Convention as follows: 
                                             - 
                                                *1.1 Description of the sewage treatment plant:  Type of sewage treatment plant ............................... Name of manufacturer ............................................. The sewage treatment plant is certified by the Administration to meet the effluent
                                                   standards as provided for in resolution MEPC.2(VI) 
- 
                                                *1.2 Description of comminuter:  Type of comminuter ............................................... Name of manufacturer ............................................ Standard of sewage after disinfection ...................... 
- 
                                                *1.3 Description of holding tank:  Total capacity of the holding tank .............................. m3 Location .................................................................. 
- 
                                                1.4 A pipeline for the discharge of sewage to a reception facility, fitted with a
                                                   standard shore connection 
 
- 
                                          2. That the ship has been surveyed in accordance with regulation 4 of Annex IV of
                                             the Convention. 
- 
                                          3. That the survey shows that the structure, equipment, systems, fittings, arrangements
                                             and material of the ship and the condition thereof are in all respects satisfactory
                                             and that the ship complies with the applicable requirements of Annex IV of the Convention. 
This Certificate is valid until ........................................................
                                        subject to surveys in accordance with regulation 4 of Annex IV of the Convention.
                                    
                                    Completion date of survey on which this Certificate is based: ...............................................
                                       dd/mm/yyyy 
                                    
                                    Issued at ....................................................
                                    
                                    (Place of issue of Certificate)   ........................
                                    
                                     ...................................................................
                                    
                                    (Date of issue)
                                    
                                     ...................................................................
                                    
                                    (Signature of authorized official issuing the Certificate)   
                                    
                                    (Seal or stamp of the authority, as appropriate) 
                                    
                                    
                                       Endorsement to extend the Certificate if valid for less than 5 years where regulation
                                          8.3. applies
                                       
                                    
                                    The ship complies with the relevant provisions of the Convention, and this Certificate
                                       shall, in accordance with regulation 8.3 of Annex IV of the Convention, be accepted
                                       as valid until ..................................................................
                                    
                                    Signed: ..........................................................
                                    
                                    (signature of authorized official) 
                                    
                                    Place: ............................................................
                                    
                                    Date: ............................................................ 
                                    
                                    (Seal or stamp of the authority, as appropriate) 
                                    
                                    
                                       Endorsement where the renewal survey has been completed and regulation 8.4 applies
                                       
                                    
                                    The ship complies with the relevant provisions of the Convention, and this Certificate
                                       shall, in accordance with regulation 8.4 of Annex IV of the Convention, be accepted
                                       as valid until ......................................................
                                    
                                    Signed: .........................................................
                                    
                                    (signature of authorized official) 
                                    
                                    Place: ...........................................................
                                    
                                    Date:............................................................ 
                                    
                                    (Seal or stamp of the authority, as appropriate) 
                                    
                                    
                                       Endorsement to extend the validity of the Certificate until reaching the port of survey
                                          or for a period of grace where regulation 8.5 or 8.6 applies
                                       
                                    
                                    This certificate shall, in accordance with regulation 8.5 or 8.6 of Annex IV of the Convention, be accepted as valid until .................................
                                    
                                    Signed: ................................................................................................
                                    
                                    (signature of authorized official) 
                                    
                                    Place: .................................................................................................
                                    
                                    Date: ..................................................................................................
                                    
                                    (Seal or stamp of the authority, as appropriate)