제18425호                                         관                 보                      2015. 1. 8.(목요일)
This is to certify:
1. That this ship has been inspected and verified to be in compliance with the requirements of
the Convention, and the provisions of the attached Declaration of Maritime Labour Compliance.
2. That the seafarers’ working and living conditions specified in Appendix A5-I of the Convention
were found to correspond to the abovementioned country’s national requirements implementing the
Convention. These national requirements are summarized in the Declaration of Maritime Labour
Compliance, Part I.
            This Certificate is valid until .............................. subject to inspections in accordance with
Standards A5.1.3 and A5.1.4 of the Convention.
This Certificate is valid only when the Declaration of Maritime Labour Compliance issued
at ......................................................... on ........................................... is attached.
Completion date of the inspection on which this Certificate is based was ...................
Issued at .................................................... on .........................................................
Signature of the duly authorized official issuing the Certificate
(Seal or stamp of issuing authority, as appropriate)
Endorsements for mandatory intermediate inspection and, if required,
any additional inspection
        This is to certify that the ship was inspected in accordance with Standards A5.1.3 and
A5.1.4 of the Convention and that the seafarers’ working and living conditions specified in
Appendix A5-I of the Convention were found to correspond to the abovementioned country’s
national requirements implementing the Convention.
Intermediate inspection:                    Signed ........................................
(to be completed between the second        (Signature of authorized official)
and third anniversary dates)                Place ..........................................
                                                     Date ...........................................
                                            (Seal or stamp of the authority,
                                            as appropriate)
Additional endorsements (if required)
        This is to certify that the ship was the subject of an additional inspection for the purpose
of verifying that the ship continued to be in compliance with the national requirements
implementing the Convention, as required by Standard A3.1, paragraph 3, of the Convention
(re-registration or substantial alteration of accommodation) or for other reasons.
Additional inspection:                           Signed .................................................................
                                                 (if required) (Signature of authorized official)
                                                 Place ...................................................................
                                                 Date ....................................................................
                                                 (Seal or stamp of the authority,
                                                 as appropriate)
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