Ship Sanitation Control Exemption Certificate

Country:

Port:

Date of issue (dd/mm/yyyy):

Certificate No.:

Name of ship:

Registry number:

Flag:

IMO number:

Gross tonnage:

Net tonnage:

Valid until (dd/mm/yyyy):

Ship owner's name and address:

This is to certify that the above ship was inspected in accordance with Article 39 of the International Health Regulations (2005) and that the ship was free of infection and contamination, including vectors and reservoirs of human disease, at the time of inspection.

Place of issue:

Date of inspection (dd/mm/yyyy):

Name and title of inspector:

Signature:

Official stamp: