DECLARATION "A"
Date | .................... |
Master | .................... |
Vessel’s Name | ................................................................................ |
Vessel’s Name | ................................................................................ |
Vessel’s Owner | ................................................................................ |
Address | ................................................................................ |
Vessel’s Operator | ................................................................................ |
Address | ................................................................................ |
Agent | ................................................................................ |
DOCUMENT | ISSUING AGENCY | ISSUE DATE | EXIPARTION DATE |
IMO Certificate | |||
Classification Society Certification | |||
Safety Equipment Certificate | |||
Safety Construction Certificate | |||
Safety Radio Telegraph Certificate | |||
Other Safety Inspections |
Master’s Signature : ........................................................