| Ship Name | IMO Number | ||
|---|---|---|---|
| Call Sign | Flag | ||
| Port of Registry | Inspection Date |
| No. | Certificate | Issued By | Issue Date | Expiry Date | Location Onboard | Verified | Remarks |
|---|---|---|---|---|---|---|---|
| 1 | Certificate of Registry | ||||||
| 2 | International Tonnage Certificate | ||||||
| 3 | International Load Line Certificate | ||||||
| 4 | Safety Management Certificate | ||||||
| 5 | Document of Compliance | ||||||
| 6 | International Oil Pollution Prevention Certificate |
| No. | Certificate | Issued By | Issue Date | Expiry Date | Location Onboard | Verified | Remarks |
|---|---|---|---|---|---|---|---|
| Name | Date | ||
|---|---|---|---|
| Signature | |||