제19066호                                관             보                  2017. 8. 4.(금요일)
Annual*/Intermediate survey*:                            Signed ................................
                                                              (Signature of duly authorized official)
                                                     Place ...................................
                                                     Date ....................................
                                             (Seal or stamp of the authority, as appropriate)
Annual survey:                                           Signed ................................
                                                              (Signature of duly authorized official)
                                                     Place ...................................
                                                     Date ....................................
                                             (Seal or stamp of the authority, as appropriate)
* Delete as appropriate.
ANNUAL/INTERMEDIATE SURVEY
                                             IN ACCORDANCE WITH REGULATION E-5.8.3
THIS IS TO CERTIFY that, at an annual/intermediate* survey in accordance with regulation
E-5.8.3 of the Annex to the Convention, the ship was found to comply with the relevant
provisions of the Convention:
                                                     Signed ................................
                                                              (Signature of authorized official)
                                                     Place ...................................
                                                     Date ....................................
                                             (Seal or stamp of the authority, as appropriate)
                             ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID
                       FOR LESS THAN 5 YEARS WHERE REGULATION E-5.3 APPLIES
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in
accordance with regulation E-5.3 of the Annex to the Convention, be accepted as valid until
...........................
                                                     Signed ................................
                                                     (Signature of authorized official)
                                                     Place ...................................
                                                     Date ....................................
                                             (Seal or stamp of the authority, as appropriate)
                           ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN
                                          COMPLETED AND REGULATION E-5.4 APPLIES
The ship complies with the relevant provisions of the Convention and this Certificate shall, in
accordance with regulation E-5.4 of the Annex to the Convention, be accepted as valid until
............................................
                                                     Signed .................................
                                                     (Signature of authorized official)
                                                     Place ...................................
                                                     Date ....................................
                                             (Seal or stamp of the authority, as appropriate)
* Delete as appropriate
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