(Official Seal)                                                                        (Country)

Issued under the provisions of the

PROTOCOL OF 1978 RELATING TO THE INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974

Type of ship:

Tanker engaged in the trade of carrying crude oil

Tanker engaged in the trade of carrying oil other than crude oil

Tanker engaged in the trade of carrying crude/other oil

Cargo ship other than a tanker engaged in the trade of carrying oil

Date of contract for building or alteration or modification of a major character ......................................................................

Date on which keel was laid or ship was at a similar stage of construction or on which an alteration or modification of a major character was commenced

Date of delivery or completion of an alteration or modification of a major character...................................................................

This Supplement shall be permanently attached to the Cargo Ship Safety Construction Certificate.

THIS IS TO CERTIFY—

That the ship has been surveyed in accordance with Regulation 10 of Chapter I of the Protocol of 1978 Relating to the International Convention for the Safety of Life at Sea, 1974; and that the survey showed that the condition of the hull, machinery and equipment as defined in the above Regulation was in all respects satisfactory and that the ship complied with the requirements of that Protocol.

This certificate is valid until

subject to intermediate survey(s) at intervals of

Issued at

(Place of issue of certificate)

....................................19...........

(Signature of duly authorised official issuing the certificate)

(Seal or stamp of the issuing authority, as appropriate)

INTERMEDIATE SURVEY

This is to certify that an intermediate survey required by Regulation 10 of Chapter I of the Protocol of 1978 Relating to the International Convention for the Safety of Life at Sea, 1974, this ship was found to comply with the relevant provisions of that Protocol.

Signed

(Signature of duly authorised official)

Place

Date

Next intermediate survey due

(Seal or stamp of the authority, as appropriate)

Signed

(Signature of duly authorised official)

Place

Date

Next intermediate survey due

(Seal or stamp of the authority, as appropriate)

Signed

(Signature of duly authorised official)

Place

Date

Next intermediate survey due

(Seal or stamp of the authority, as appropriate)

Signed

(Signature of duly authorised official)

Place

Date

Next intermediate survey due

(Seal or stamp of the authority, as appropriate)