ANNEXURE A

DEPARTMENT OF TRANSPORT

Reference No. ........................

CERTIFICATE OF INSURANCE OR OTHER FINANCIAL SECURITY IN RESPECT OF CIVIL LIABILITY FOR OIL POLLUTION DAMAGE

Issued in accordance with the provisions of Article VII of the International Convention on Civil Liability for Oil Pollution Damage 1969 and sections 13 and 14 of the Marine Pollution (Control and Civil Liability) Act 1981 (Act No. 6 of 1981).

This is to certify that there is in force in respect of the above-named ship a contract of insurance or other financial security satisfying the requirements of Article VII of the said Convention and section 13 of the said Act.

Type of security ...........................................................................................................

Period of validity of security ........................................................................................

Name and address of the person providing the security:

Name ..........................................................................................................................

Address .......................................................................................................................

....................................................................................................................................

This certificate is valid until .............................

Issued on the authority of the Government of the Republic of South Africa at ................... on ...........................................

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Director-General: Transport