(Note: This Certificate shall have a Declaration of Maritime Labour Compliance attached)

Issued under the provisions of Article V and Title 5 of the Maritime Labour Convention, 2006

(referred to below as “the Convention”) under the authority of the Government of:

..........................................................................................

(full designation of the State whose flag the ship is entitled to fly)

by .........................................................................................

(full designation and address of the competent authority or recognized organization duly authorized under the provisions of the Convention)

Particulars of the ship

Name of ship ..........................................................................................

Distinctive number or letters .........................................................................

Port of registry .........................................................................................

Date of registry ........................................................................................

Gross tonnage

1 For ships covered by the tonnage measurement interim scheme adopted by the IMO, the gross tonnage is that which is included in the REMARKS column of the International Tonnage Certificate (1969). See Article II(1)(c) of the Convention.

....................................................................................................................

IMO number ............................................................................................

Type of ships ..................................................................................................

Name and address of the shipowner

2 Shipowner means the owner of the ship or another organization or person, such as the manager, agent or bareboat charterer, who has assumed the responsibility for the operation of the ship from the owner and who, on assuming such responsibility, has agreed to take over the duties and responsibilities imposed on shipowners in accordance with this Convention, regardless of whether any other organization or persons fulfil certain of the duties or responsibilities on behalf of the shipowner. See article II(1)(j) of the Convention.

............................................................................................................................................................................................................................................................

This is to certify:

1. That this ship has been inspected and verified to be in compliance with the requirements of the Convention, and the provisions of the attached Declaration of Maritime Labour Compliance.

2. That the seafarers' working and living conditions specified in Appendix A5-1 of the Convention were found to correspond to the abovementioned country's national requirements implementing the Convention. These national requirements are summarized in the Declaration of Maritime Labour Compliance, Part I.

This Certificate is valid until .......................... subject to inspections in accordance with Standards A5.1.3 and A5.1.4 of the Convention.

This Certificate is valid only when the Declaration of Maritime Labour Compliance issued at ................................................ on ......................................................... is attached.

Completion date of the inspection on which this Certificate is based was ....................................

Issued at .................................. on .................................................................

Signature of the duly authorized official issuing the Certificate

(Seal or stamp of issuing authority, as appropriate)

Endorsements for mandatory intermediate inspection and, if required, any additional inspection

This is to certify that the ship was inspected in accordance with Standards A5.1.3 and A5.1.4 of the Convention and that the seafarers' working and living conditions specified in Appendix A5-1 of the Convention were found to correspond to the abovementioned country's national requirements implementing the Convention.

Intermediate inspection: (to be completed between the second and third anniversary dates) | Signed ..................................................... (Signature of authorized official) ......................................................

Place ............................................

Date .............................................. (Seal or stamp of the authority, as approriate)

Additional endorsements (if required)

This is to certify that the ship was the subject of an additional inspection for the purpose of verifying that the ship continued to be in compliance with the national requirements implementing the Convention, as required by Standard A3.1, paragraph 3, of the Convention (re-registration or substantial alteration of accommodation) or for other reasons.

Additional inspection: (if required) | Signed ......................................................... (Signature of authorized official)

Place ...............................................

Date ...............................................

(Seal or stamp of the authority, as appropriate)

Additional inspection: (if required) | Signed ......................................................... (Signature of authorized official) ..............................................................

Place ...............................................

Date ...............................................

(Seal or stamp of the authority, as appropriate)

Additional inspection: (if required) | Signed ......................................................... (Signature of authorized official)

Place ...............................................

Date ...............................................

(Seal or stamp of the authority, as appropriate)

Maritime Labour Convention, 2006

Declaration of Maritime Labour Compliance - Part I

(Note: This Declaration must be attached to the ship's Maritime Labour Certificate)

Issued under the authority of: Insert name of competent authority as defined in Article II, paragraph 1(a), of the Convention)

With respect to the provisions of the Maritime Labour Convention, 2006, the following referenced ship:

Name of ship | IMO number | Gross tonnage

is maintained in accordance with Standard A5.1.3 of the Convention.

The undersigned declares, on behalf of the abovementioned competent authority, that:

(a) the provisions of the Maritime Labour Convention are fully embodied in the national requirements referred to below;

(b) these national requirements are contained in the national provisions referenced below; explanations concerning the content of those provisions are provided where necessary;

(c) the details of any substantial equivalencies under Article VI, paragraphs 3 and 4, are provided <under the corresponding national requirement listed below><in the section provided for this purpose below> (strike out the statement which is not applicable);

(d) any exemptions granted by the competent authority in accordance with Title 3 are clearly indicated in the section provided for this purpose below; and

(e) any ship-type specific requirements under national legislation are also referenced under the requirements concerned.

1. Minimum age (Regulation 1.1)....................

2. Medical certification (Regulation 1.2)

3. Qualifications of seafarers (Regulation 1.3)

4. Seafarers' employment agreements (Regulation 2.1)

5. Use of any licensed or certified or regulated private recruitment and placement service (Regulation 1.4)

6. Hours of work or rest (Regulation 2.3)

7. Manning levels for the ships (Regulation 2.7)

8. Accommodation (Regulation 3.1)

9. On-board recreational facilities (Regulation 3.2)

10. Food and catering (Regulation 3.2)

11. Health and safety and accident prevention (Regulation 4.3)

12. On-board medical care (Regulation 4.1)

13. On-board complaint procedures (Regulation 5.1.5)