Model Form of Flag State Verification and Acceptance Document
FLAG STATE VERIFICATION AND ACCEPTANCE DOCUMENT
(Official seal) (State)
Issued under the provisions of the
GUIDELINES FOR VESSELS WITH
DYNAMIC POSITIONING SYSTEMS
(MSC/Circ...)
under the authority of the Government of
__________________________________________
(full designation of the State)
by _________________________________________________ ____
(full official designation of the competent person or
organization authorized by the Administration)
Distinctive identification(Name or number) | Type | Port of registry | Official IMO-number |
| | | |
Date on which keel was laid or vessel was at similar stage of construction or on which
major conversion was commenced............................................................................
THIS IS TO CERTIFY that the above-mentioned vessel has been duly documented,
surveyed, and tested in accordance with the Guidelines for Vessels with Dynamic
Positioning Systems (MSC/Circ...)and found to comply with the Guidelines.
The vessel is allowed to operate in DP Equipment Class.............................................................
and in lower equipment classes.
This document remains valid until...............................................................................................
unless terminated by the Administration, provided that the vessel is operated, tested, and
surveyed according to the requirements in the guidelines and the results are properly
recorded.
Issued at ..................................................................................................................................
(Place of issue of document)
....................... ...............................................................................................
(Date of issue) (Signature of authorized official issuing the certificate)
................................................................................................................................................
(Seal or stamp of the issuing authority, as appropriate)
LIST OF EXEMPTIONS AND EQUIVALENTS
(ref. items 1.4 and 1.5 of the Guidelines)
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
LIST OF MAIN SYSTEMS AND COMPONENTS COVERED BY FSVAD*
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
* All main systems and components included in the dynamic positioning system are to be listed in a
systematic way. As an alternative reference can be made to drawings, etc. It is important that it is possible
by this list to identify all systems and components covered by FSVAD. Software versions should also be
identified. Equipment installed after date of issuing FSVAD should only be included in the list after control
and testing has been completed and modifications and non-conformities report signed.
Record of annual survey reports, and special (5 years) survey reports
Date | Test type | Remarks | *Report Reference Date/Number | Sign. of appointed surveyor(IR) | Sign. of Master/Platform Manager |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
* All reports should be filed together with this FSVAD for use during later testing and inspections by
nominated surveyors, flag State surveyors, etc.
IR = if required, ref. item 5.1.2