제17128호                                          관                   보                         2009.11.10. (화요일)

                       Distinctive                 IMO Ship                                Name and full address of the
   Name of                                                                  Port of
                       Number or                 Identification                            principal place of business of
    Ship                                                                    Registry
                         letters                    Number                                     the registered owner.




This is to certify that there is in force in respect of the above-named ship a policy
of insurance or other financial security satisfying the requirements of article 7 of the
International Convention on Civil Liability for Bunker Oil Pollution Damage, 2001.
Type of Security ..............................................................................................................
Duration of Security ........................................................................................................
Name and address of the insurer(s)and/or guarantor(s)
Name ......................................................................................................................
Address ..................................................................................................................
This certificate is valid until ..........................................................................................
Issued or certified by the Government of ....................................................................
                                                               (Full designation of the State)

OR
The following text should be used when a State Party avails itself of article 7(3)
The present certificate is issued under the authority of the Government of .
...................................................by...................................................................
(full designation of the State) (name of institution or organization)
At.......................................................... On .............................................................
                         (Place)                                                              (Date)
.................................................................................................................
       (Signature and Title of issuing or certifying official)
Explanatory Notes:
  1. If desired, the designation of the State may include a reference to the competent
     public authority of the country where the Certificate is issued.
  2. If the total amount of security has been furnished by more than one source, the
     amount of each of them should be indicated.
  3. If security is furnished in several forms, these should be enumerated.
  4. The entry “Duration of Security” must stipulate the date on which such security
     takes effect.
  5. The entry “Address” of the insurer(s) and/or guarantor(s) must indicate the principal
     place of business of the insurer(s) and/or guarantor(s). If appropriate, the place of
     business where the insurance or other security is established shall be indicated.

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