appropriate)
Form R (Safety Radio Certificate for Cargo Ships)
CARGO SHIP SAFETY RADIO CERTIFICATE
This Certificate shall be supplemented by a Record of Equipment of Radio
Facilities (Form R)
(Official seal) (State)
Issued under the provisions of the
INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974,
as modified by the Protocol of 1988 relating thereto under the
authority of the Government of
--------------------------------------------------------------------
(name of the State) by ------------------------
--------------------------------------------
(person or organization authorized)
Particulars of ship ①
[ ① Alternatively, the particulars of the ship may be placed
horizontally in boxes.]
Name of ship ---------------------------------------------------------
Distinctive number or letters ----------------------------------------
Port of registry -----------------------------------------------------
Gross tonnage --------------------------------------------------------
Sea areas in which ship is certified to operate
(Regulation IV/2) ----------------------------------------------------
IMO Number② --------------------------------------------------------
[ ② In accordance with resolution A. 600(15)-IMO ship Identification
Number Scheme, this information may be included voluntarily.]
Date on which keel was laid or ship was at a similar stage of
construction or, where applicable, date on which work for a conversion or
an alteration or modification of a major character was commenced ---------
THIS IS TO CERTIFY:
1 That the ship has been surveyed in accordance with the requirements
of regulation I/9 of the Convention.
2 That the survey showed that:
2.1 the ship complied with the requirements of the Convention as
regards radio installations;
2.2 the functioning of the radio installations used in life-saving
appliances complied with the requirements of the Convention;
3 That an Exemption Certificate has/has not ① been issued.
[ ① Delete as appropriate.]
This certificate is valid until ----------------------② subject to
the periodical surveys in accordance with regulation I/9 of the Convention
[ ② Insert the date of expiry as specified by the Administration in
accordance with regulation I/14 (a) of the Convention. The day and the
month of this date correspond to the anniversary date as defined in
regulation I/2 (n) of the Convention, unless amended in accordance with
regulation I/14 (h).]
Issued at ------------------------------------------------------------
(Place of issue of certificate)
----------------------------- --
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