320 



This is to certify that; 



(1) The ship is equipped with 



(a) a to: 



/ (Description of equipment used) 



(i) collect and hold the sewage* 



(ii) treat the sewage so as to be able to meet the 



requirements cf Regulation 4(l)(b) of Annex IV of 

 the said Convention.* 



(b) a pipeline for the discharge of sewage to a reception facility, 

 and that such pipeline is fitted with a standard shore 

 connection in compliance with Regulation [7] of Annex IV of 

 the above said Convention 16/ 



(2) The ship has been sxirveyed in accordance with the provisions of 

 Annex TV to the International Convention for the Prevention of 

 Pollution fr<^m Ships, 1973 » concerning the Prevention of Pollution 

 by Sewage, and that the survey showed that the ship complied with 

 the applicable requirements of Annex IV of the said Convention, 



This Certificate is valid until the day of 



19 



Issued at ••...••«. 



(Place of issue of certificate) 



19 



(Date of issue) (Signature of official issuing the 



certificate and/or seal of iss\iing 

 authority) 



If signed, the following paragraph is to be added; 



The undersigned declares that he is duly authorized by the 

 said Government to issue this Certificate, 



* Delete as appropriate 



16/ See Footnote 5 in Regulation 3(5) (b). 



