FEDERAL COMMUNICATIONS COMMISSION Approved by OMB

 3060-0228

 Estimated Time Per Response: 10 Minutes

 

CARGO SHIP SAFETY RADIO CERTIFICATE

United States of America

Issued Under the Provisions of the International Convention for the Safety of Life at Sea, 1974, as amended in 1988

 

Name of Ship Distinctive Number

or Letters

Port of Registry Gross 

Tonnage

Date on Which 

Keel was Laid 

(see note below)

 

The Government of the United States of American certifies:

1. That the above named ship has been surveyed in accordance with the requirements of regulation 1/9 

of the Convention;

2. That the survey showed that the ship complies with the requirements of the Convention as regards to 

radio installations;

3. That the vessel is certified to operate in Sea Areas _______________________ (regulation IV/2);

4. That the functioning of the radio installations used on life-saving appliances complies with the 

requirements of the convention;

5. That the details of the radio equipment installation conform to the accompanying Record of Equipment 

or Radio Facilities that accompanies this Certificate;

6. That an Exemption Certificate has (has not) been issued.

This certificate will remain in force until: _______________________________________________________________________

Issued at: _______________________________________________________________________________________________

(Place of issue of certificate)

__________________________________ _____________________________________________________________

(Date of Issue) (Signature of licensed inspector)

 _____________________________________________________________

 (Typed or Printed Name of licensed inspector)

 _____________________________________________________________

 (FCC license number of issuing inspector)

Note: It will be sufficient to indicate the year in 

which the keel was laid except for 1952, 1965, 

1980, 1992, and 1995 in which cases the actual 

date shown be given.

 

 

 FCC Form 829 – Page 1

 August 2012
 Approved by OMB

 3060-0228

 

RECORD OF EQUIPMENT OF RADIO FACILITIES FOR

COMPLIANCE WITH THE INTERNATIONAL CONVENTION FOR THE 

SAFETY OF LIFE AT SEA, 1974, AS AMENDED IN 1988

1. Particulars of ship

Name of Ship ____________________________________________ Call Sign ______________________________________

Official Number __________________________________________ Port of Registry _________________________________

Minimum number of persons with required qualifications to operate the radio installations _______________________________

2. Details of radio facilities

 Item Actual Provision

1 Primary Systems

1.1 VHF radio installation

1.1.1 DSC encoder....................................................................................... _______________________________

1.1.2 DSC watch receiver.............................................................................. _______________________________

1.1.3 Radiotelephony.................................................................................... _______________________________

1.2 MF radio installation

1.2.1 DSC encoder........................................................................................ _______________________________

1.2.2 DSC watch receiver................................................................................ _______________________________

1.2.3 Radiotelephony..................................................................................... _______________________________

1.3 MF/HF radio installation

1.3.1 DSC encoder........................................................................................ _______________________________

1.3.2 DSC watch receiver............................................................................... _______________________________

1.3.3 Radiotelephony..................................................................................... _______________________________

1.3.4 Direct printing radiotelegraphy.................................................................. _______________________________

1.4 INMARSAT ship earth station................................................................... _______________________________

2 Secondary means of alerting..................................................................... _______________________________

3 Facilities for reception of maritime safety information

3.1 NAVTEX receiver.................................................................................. _______________________________

3.2 EGC receiver........................................................................................ _______________________________

3.3 HF direct printing radiotelegraph receiver.................................................... _______________________________

4 Satellite EPIRB

4.1 COSPAS-SARSAT................................................................................. _______________________________

4.2 IMMARSAT........................................................................................... _______________________________

5 VHF EPIRB........................................................................................... _______________________________

6 Ship’s radar transponder.......................................................................... _______________________________

7 Radiotelephone distress frequency

 watch receiver on 2182 kHz..................................................................... _______________________________

8 Device for generating the radiotelephone

 Alarm signal on 2182 kHz........................................................................ _______________________________

 

 FCC Form 829 – Page 2

 August 2012
Approved by OMB

 3060-0228

 

3. Methods used to ensure availability of radio facilities (regulations IV/15.6 and 15.7) (at least one required for sea areas A1 and 

A2, at least two for A3 and A4)

 Item Actual Provision

 

3.1. Duplication of equipment...................................................................... _______________________________

3.2 Shore-based maintenance..................................................................... _______________________________

3.3 At-sea maintenance capability............................................................... _______________________________

4. Ships constructed before 1 February 1995 which do not comply with all the applicable requirements of Chapter IV of the 

convention as amended in 1988

4.1 For ships required to be fitted with radiotelegraphy in accordance with the Co nvention in force prior to 1 February 1992.

 Requirements of 

 Item regulations Actual Provision

 

Hours of listening by operator............... ____________________________ ____________________________________

Number of operators........................... ____________________________ ____________________________________

Whether auto alarm fitted..................... ____________________________ ____________________________________

Whether main installation fitted.............. ____________________________ ____________________________________

Whether reserve installation fitted.......... ____________________________ ____________________________________

Whether main and reserve transmitters... ____________________________ ____________________________________

electronically separated or combined...... ____________________________ ____________________________________

4.2 For ships required to be fitted with radiotelegraphy in accordance with the Convention in force prior to 1 February 1992.

 Requirements of 

 Item regulations Actual Provision

 

Hours of listening by operator............... ____________________________ ____________________________________

Number of operators........................... ____________________________ ____________________________________

 THIS IS TO CERTIFY that this record is correct in all respects

 Issued at: ___________________________________________

 (Place of issue of the Record)

__________________________________ _____________________________________________________________

(Date of Issue) (Signature of inspector)

 _____________________________________________________________

 (FCC license number of issuing inspector)

 

 

 FCC Form 829 – Page 3

 August 2012
OMB Control Number 3060-0228

Notice to Individuals Required by the Privacy Act of 1974 and the Paperwork Reduction Act of 1995

The solicitation of information requested in this form is authorized by th e Communications Act of 1934, as amended. The 

Commission will use FCC-licensed technicians to conduct ship inspections and determine if the radio installation is in compliance

with the requirements of the Communications Act of 1934, as amended. All information provided in this form, as well as the form 

itself, will be available for public inspection.

Public reporting burden for this collection of information is estimated to average 10 minutes per response. Our estimate includes the 

time to read the instructions, look through existing records, gather and maintain required d ata, and actually complete and review the 

form or response. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it 

causes you, please write the Federal Communications Commission, Office of Managing Director, AMD-PERM, Washington, DC 

20554, Paperwork Reduction Act Project (3060-0228). We will also accept your PRA comments via the internet if you sent an email to PRA@fcc.gov.

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information 

sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently 

valid OMB control number and/or we fail to provide you with this notice. This collection has been assigned an OMB control number 

of 3060-0228.

THIS NOTICE IS REQUIRED BY THE PRIVACY ACT OF 1974, PUBLIC LAW 93-579, DECEMBER 31,1974, 5 U.S.C. SECTION 

552a(e)(3) AND THE PAPERWORK REDUCTION ACTION OF 1995, PUBLIC LAW 104-13, OCTOBER 1,1995, 44 U.S.C. 

SECTION 3507.

 FCC Form 829 – Page 4

 August 2012