제16915호                                          관                   보                         2009. 1. 9. (금요일)
Active ingredient(s) and their Chemical Abstract Services Registry Number(s) (CAS numbe
r(s)).............................................................
Type(s) of sealer coat, if applicable...........................................
Name(s) and colour(s) of sealer coat applied, if applicable.........................
Date of application of sealer coa ................................................................
 Signed:.....................................................................................
 (Signature of authorized official issuing the Record)
 Place:.........................................................................................
 Date6):..........................................................................................
                                            (Seal or stamp of the authority)
                                                APPENDIX 2 TO ANNEX 4
                     MODEL FORM OF DECLARATION ON ANTI-FOULING SYSTEM
                                    DECLARATION ON ANTI-FOULING SYSTEM
                                                     Drawn up under the
International Convention on the Control of Harmful Anti-Fouling Systems on Ships
Name of ship.....................................................................
Distinctive number or letters.....................................................................
Port of registry.....................................................................
Length.....................................................................
Gross tonnage.....................................................................
IMO number (if applicable)......................................................................
I declare that the anti-fouling system used on this ship complies with Annex 1 of the
  Convention.
........................................................................................................................................
(Date)                (Signature of owner or owner’s authorized agent)
                                   Endorsement of anti-fouling system(s) applied
Type(s) of anti-fouling system(s) used and date(s) of application ......................................
........................................................................................................................................
 (Date)               (Signature of owner or owner’s authorized agent)
Type(s) of anti-fouling system(s) used and date(s) of application .....................................
................................
........................................................................................................................................
(Date)                    (Signature of owner or owner’s authorized agent)
Type(s) of anti-fouling system(s) used and date(s) of application ........................................
........................................................................................................................................
 (Date)                (Signature of owner or owner’s authorized agent)
6)Date of completion of the survey on which this endorsement is made


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