319 



APPENDIX 



International Sewage 

 Pollution Prevention Certificate (1973) 



(official Seal) 



Issued under the Provisions of the International Convention for the Prevention 

 jf Pollution from Ships, 1975 » under the Authority of the Government of 



by 



(full designation rf the coiontry) 



(full designation of the competent person or 

 organization recognized under the provisions of 

 the International Convention for the Prevention 

 of Pollution from Ships, 1975) 



Name of 

 Ship 



Distinctive 



Ntunber or 



Letter 



Port of 

 Registry 



Gro3s 



Tonnage 



Type of ship.. 



No. of beds on board (if no gnss tonnage figure is quoted)—^ , 

 Date of which keel waa laid or ship was in a similar stage of 



construction 



Date of building contract or date of conversion 



Date of delivery , 



15/ 



1/, 



See footnote -^ under Regulation 2. 



The actual wording is conditional on decision taken on Regulation 2, 



