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Annex — Certificate of insurance or other financial security in respect of civil liability for oil pollution damage Protocol van 1992 tot wijziging van het Internationaal Verdrag inzake de wettelijke aansprakelijkheid voor schade door verontreiniging door olie, 1969

Certificate of insurance or other financial security in respect of civil liability for oil pollution damage

Issued in accordance with the provisions of Article VII of the International Convention on Civil Liability for Oil Pollution Damage, 1992.

Name of ship | Distinctive number or letters | Port of registry | Name and address of 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 VII of the International Convention on Civil Liability for Oil Pollution Damage, 1992.

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)

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.

Regeling
Protocol van 1992 tot wijziging van het Internationaal Verdrag inzake de wettelijke aansprakelijkheid voor schade door verontreiniging door olie, 1969
Afkortingen
CLC Protocol, CLC Protocol 1992, WA-Protocol
Soort
Verdrag
Geldend vanaf
01-11-2003
BWB-id
BWBV0003263
Versie
2003-11-01_0

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