附件
油污损害民事责任保险或其它财务
保证证书
CERTIFICATE OF INSURANCE OR OTHER
FINANCIAL SECURITY IN RESPECT OF CIVIL
LIABILITY FOR OLL POLLUTION DAMAGE
根据1992年国际油污损害民事责任公约第七条的规定颁发。
Issued in accordance with the provisions of Article vn of the Internatilonal Convention on Civil Liability for Oil Pollution Damage, 1992.
船名
Name of ship
识别号码或呼号
Distinctive number or letters
船籍港
Port of registry
船舶所有人名称和地址
Name and address
Of Owner
兹证明,上述船舶按照1992年国际油污损害民事责任公约第七条的要求取得的保险或其它财务担保是有效的。
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 vn of theInternational Convention on Civil Liability for Oil Pollution Damage, 1992.
保证类别
Type of Security
保证期限
Duration of Security
保险人和/或保证人的名称和地址
Name and Address of the Insurers(s) and/or fGuarantor(s)
名称
Name
地址
Address
本证书的有效日期至:
This certificate is valid until
颁发证书或签证的政府:
Issued or certified by the Governmem of
(国家全称) (Full designation of the State)
于 日期
at on
on(地点)(Place) (日期)(Date)
颁发或签证官员的签字和官街
Signature and Title of
Issuing or certifying official
(证书填写)注解:
1.如果愿意,颁发国名称中可包括颁发证书的国家主管当局的名称。
2.如担保总额由一个以上的来源所提供,应列明每一来源的数额。
3.如担保是以多种方式提供,应将各种方式一一列举。
4.填写“保证期限”时必须注明该保证的生效日期。