CI 78 SAFETY OF LIFE AT SEA 



App. 



Form of Safety Radiotelephony Certificate for Cargo Ships 

 CARGO SHIP SAFETY RADIOTELEPHONY CERTitlCATE 



{Official Seal) {Country) 



Issued under the provisions of the 



International Convention for the Safety of Life at Sea, 1960 



Distinctive Date on which 



Name of Ship Number or Port of Registry Gross keel was laid 



Letters Tonnage (see Note 



below) 



The {Name) Government certifies 



I, the undersigned {Name) certify 



I. That the above-mentioned ship complies with the provisions of the 

 Regulations annexed to the Convention referred to above as regards 

 Radiotelephony : — 



Requirements of 

 Regulations Actual provision 



Hours of listening 



Number of operators 



II. That the functioning of the portable radio apparatus for survival craft, 

 if provided, complies with the provisions of the said Regulations. 



This certificate is issued under the authority of the 

 Government. It will remain in force until 



Issued at the day of 19 . 



Here follows the seal or signature of the authority entitled to issue this 

 certificate. 



{Seal) 

 If signed, the following paragraph is to be added: — 



The undersigned declares that he is duly authorised by the said Government 

 to issue this certificate. 



{Signature) 



Note. — It will be sufficient to indicate the year in which the keel was laid except for 1952 

 and the year of the coming into force of the International Convention for the Safety of Life 

 at Sea, 1960, in which cases the actual date should be given. 



App. 



Ex. Doc. K. 87-1 O— — 14 



