FORM
OFWING-IN-GROUNDCRAFTSAFETYCERTIFICATEAND RECORDOFEQUIPMENT
WING-IN-GROUND
CRAFTSAFETYCERTIFICATE
ThisCertificateshouldbesupplementedbyaRecordofEquipment
(Officialseal) (State)
Issuedundertheprovisionsofthe
INTERIMGUIDELINESFORWIGCRAFT
(MSC/Circ.1054)
undertheauthorityoftheGovernmentof
...............................................................................................................
(fulldesignationoftheState)
by...........................................................................................................
(fullofficialdesignationofthecompetentpersonor
organizationauthorizedbytheAdministration)
Particularsofcraft*
Nameofcraft...........................................................................................................................................
Manufacturer'smodelandhullnumber...................................................................................................
Distinctivenumberorletters....................................................................................................................
IMOnumber**.........................................................................................................................................
Portofregistry........................................................................................................................................
Grosstonnage.........................................................................................................................................
Designwaterlinecorrespondingtodraughtsatdraughtmarksof.........forward,.........aft
Category Assistedpassengercraft/unassistedpassengercraft/cargocraft*
Crafttype WIGcraft,TypeA/B/C,monohull/multihull/other(givedetail.................)*
Dateonwhichkeelwaslaidorcraftwasat
asimilarstageofconstructionoronwhich
amajorconversionwascommenced.......................................................................................................
THISISTOCERTIFY:
1 That the above-mentioned craft has been duly surveyed in accordance with the applicable provisionsoftheInterimGuidelinesforWIGcraft.
2 Thatthesurveyshowedthatthestructure,equipment,fittings,radiostationarrangementsand materialsofthecraftandtheconditionthereofareinallrespectssatisfactoryandthatthecraftcomplies withtherelevantprovisionsoftheInterimGuidelines.
3 Thatthelife-savingappliancesareprovidedforatotalnumberof.....personsandnomoreas follows:
.................................................................................................................................................................
.................................................................................................................................................................
4 That,inaccordancewith11,PartA,thefollowingequivalentshavebeengrantedinrespectofthe craft:
paragraph ....................................... equivalentarrangement
.......................................
....................................... ......................................
Thiscertificateisvaliduntil.....................................................................................................................
Issuedat........................................................................................................................................................................
(Placeofissueofcertificate)
....................... .........................................................................................
(Dateofissue) (Signatureofauthorizedofficialissuingthecertificate)
.......................................................................................
(Sealorstampoftheissuingauthority,asappropriate)
Endorsement
forperiodicalsurveys
Thisistocertifythat,atasurveyrequiredby6,PartA,thiscraftwasfoundtocomplywiththerelevant provisionsoftheInterimGuidelines.
Periodicalsurvey: Signed:...................................................................................
(Signatureofauthorizedofficial)
Place: ................................................................................... Date: ...................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:.....................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:......................................................................................... Date: .....................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Endorsement
toextendtheCertificateifvalidforlessthan5yearswhere9.8,PartA,applies
Thiscraftcomplieswiththerelevantrequirements
Periodicalsurvey: Signed:...................................................................................
(Signatureofauthorizedofficial)
Place: ................................................................................... Date: ...................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:.....................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:......................................................................................... Date: .....................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Periodicalsurvey: Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Endorsement
toextendtheCertificateifvalidforlessthan5yearswhere9.8,PartA,applies
ThiscraftcomplieswiththerelevantrequirementsoftheInterimGuidelines,andthisCertificateshould,
inaccordancewith9.8,PartA,beacceptedasvaliduntil.................................................
Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Endorsement
wheretherenewalsurveyhasbeencompletedand9.9,PartA,applies
ThiscraftcomplieswiththerelevantprovisionsoftheInterimGuidelines,andthisCertificateshould,in accordancewith9.9,PartA,beacceptedasvaliduntil.......................................
Signed:.....................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Endorsement
to
extend
the
validity
of
the
Certificate
until
reaching
the
port
of
survey
where
9.10, Part
A,applies
ThisCertificateshould,inaccordancewith9.10,PartA,beacceptedasvaliduntil................... Signed:......................................................................................
(Signature ofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Endorsement
fortheadvancementoftheanniversarydatewhere9.13,PartA,applies
Inaccordancewith9.13,PartA,thenewanniversarydateis...................................................... Signed:......................................................................................
(Signature ofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
Inaccordancewith9.13,PartA,thenewanniversarydateis...................................................... Signed:......................................................................................
(Signatureofauthorizedofficial)
Place:........................................................................................ Date: ........................................................................................
....................................................................................
(Sealorstampofauthority,asappropriate)
________________________
* Alternatively,theparticularsofthecraftmaybeplacedhorizontallyinboxes.
** InaccordancewiththeIMOshipidentificationnumberscheme,adoptedbytheOrganizationby resolutionA.600(15).
* Deleteasappropriate.