Title AFS2001/Appendices

Appendix 1 to Annex 4

INTERNATIONAL ANTI-FOULING SYSTEM CERTIFICATE

(This certificate shall be supplemented by a Record of Anti-fouling Systems)

(Officialseal) (State)
Issuedunderthe
InternationalConventionontheControlofHarmfulAntiFoulingSystems
onShips
undertheauthorityoftheGovernmentof
...............................................
(nameoftheState)

by
...............................................
(Personororganizationauthorized)
WhenaCertificatehasbeenpreviouslyissued,thisCertificatereplacesthe
certificatedated......

ER
Particularsofship1)
Nameof ST
ship...................................................................................................................
GI
Distinctivenumberor
letters..............................................................................................
RE

Port
ofregistry.................................................................................................................
AN

Gross
tonnage.................................................................................................................
RE

IMO
Number2).................................................................................................................
KO

AnantifoulingsystemcontrolledunderAnnex1hasnotbeenappliedduringor
after
constructionofthisship............................................................................................

AnantifoulingsystemcontrolledunderAnnex1hasbeenappliedonthisship
previously,but
hasbeenremovedby.......(insertnameofthefacility)on....(date)
..............................
AnantifoulingsystemcontrolledunderAnnex1hasbeenappliedonthisship
previously,buthasbeenremoved
by.................................................................(insertnameofthefacility)
.................................................................on..................(date)...............................
AnantifoulingsystemcontrolledunderAnnex1wasappliedonthisshippriorto
(date)3,but
mustberemovedorcoveredwithasealercoatprior
to..........(date)4............................

THISISTOCERTIFYTHAT:
1theshiphasbeensurveyedinaccordancewithregulation1ofAnnex4tothe
Conventionand
2thesurveyshowsthattheantifoulingsystemontheshipcomplieswiththe
applicablerequirementsofAnnex1totheConvention.

Issued
at.......................................................................................................................
(PlaceofissueofCertificate)
Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register of Shipping is not
.......................................................................................................
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service. 1/5
(Dateofissue)(Signatureofauthorizedofficialissuingthe
 at.......................................................................................................................
(PlaceofissueofCertificate)

.......................................................................................................
(Dateofissue)(Signatureofauthorizedofficialissuingthe
Certificate)

Dateofcompletionofthesurvey
onwhichthiscertificateisissued:....................

______________
1)Alternatively,theparticularsoftheshipmaybeplaced
horizontallyinboxes.

2)InaccordancewithIMOshipIdentificationNumberScheme
adoptedbytheOrganizationbyresolutionA.600(15).

3)Dateofentryintoforceofthecontrolmeasure.

4)Dateofexpirationofanyimplementationperiodspecifiedin
article4(2)orAnnex1.

ER
ST
GI
RE

RECORD OF ANTI-FOULING SYSTEMS

AN

ThisRecordshallbepermanentlyattachedtotheInternationalAntiFouling
RE

SystemCertificate.
KO

Particularsofship
Nameofship:...............................................
Distinctivenumberorletters:...............................................
IMOnumber:...............................................
Detailsofantifoulingsystem(s)applied

Type(s)ofantifoulingsystem(s)
used...............................................................................
...................................................................................................................................
....................................................................................................................................
Date(s)ofapplicationofantifouling
system(s)...................................................................

Name(s)ofcompany(ies)andfacility(ies)/location(s)where
applied......................................
....................................................................................................................................

Name(s)ofantifoulingsystem
manufacturer(s).................................................................
....................................................................................................................................
Name(s)andcolour(s)andcolour(s)ofantifouling
system(s)..............................................
....................................................................................................................................

Activeingredient(s)andtheirChemicalAbstractServicesRegistryNumber(s)
(CASnumber(s))
....................................................................................................................................
Type(s)ofsealercoat,of
Disclaimer Although allapplicable..................................................................................
possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register of Shipping is not
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service. 2/5
....................................................................................................................................
 Activeingredient(s)andtheirChemicalAbstractServicesRegistryNumber(s)
(CASnumber(s))
....................................................................................................................................
Type(s)ofsealercoat,of
applicable..................................................................................
....................................................................................................................................
Name(s)andcolour(s)ofsealercoatapplied,ifapplicable
....................................................................................................................................

Dateofapplicationofsealercoat
.....................................................................................
THISISTOCERTIFYthatthisRecordiscorrectinallrespects.

Issued
at........................................................................................................................
(PlaceofissueofRecord)

.......................................................................................................
(Dateofissue)(Signatureofauthorizedofficialissuingthe
Certificate)

Endorsement of the Records 5)

ER
THISISTOCERTIFYthatasurveyrequiredinaccordancewithregulation1(1)
(b)ofAnnex4totheConventionfoundthattheshipwasincompliancewiththe ST
Convention
GI

Detailsofantifoulingsystem(s)applied
RE

Type(s)ofantifoulingsystem(s)
AN

used...............................................................................
.....................................................................................................................................
RE

Date(s)ofapplicationofantifouling
KO

system(s)...................................................................

Name(s)ofcompany(ies)andfacility(ies)location(s)there
applied........................................
.....................................................................................................................................

Name(s)ofantifoulingsystem(s)
manufacturer(s)..............................................................
....................................................................................................................................
Name(s)andcolour(s)ofantifouling
system(s)..................................................................
....................................................................................................................................
Activeingredient9s)andtheirChemicalAbstractServicesRegistryNumber(s)
(CASnumber(s))
.....................................................................................................................................
Type(s)ofsealercoat,if
applicable....................................................................................

Name(s)andcolour(s)ofsealercoatapplied,ifapplicable
.....................................................................................................................................
Dateofapplicationofsealer
coat.......................................................................................

Signed:................................................................................
(SignatureofauthorizedofficialissuingtheRecord)
Place:..................................................................................
Date:6)................................................................................
Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register of Shipping is not
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service. 3/5

(Sealorstampoftheauthority)
 (SignatureofauthorizedofficialissuingtheRecord)
Place:..................................................................................
Date:6)................................................................................

(Sealorstampoftheauthority)

_________________
5)Thispageofrecordshallbereproducedandaddedtothe
RecordasconsiderednecessarybytheAdministration

6)Dateofcompletionofthesurveyonwhichthisendorsementis
made.

Appendix 2 to Annex 4

Model from of declaration on Anti-Fouling System

DECLARATION ON ANTI-FOULING SYSTEM

ER
Drawnupunderthe ST
InternationalConventionontheControlofHarmfulAntiFoulingSystemson
GI
Ships
RE

Nameofship...................................................................................................................
AN

Distinctivenumberorletters.............................................................................................
RE

Portofregistry.................................................................................................................
KO

Length............................................................................................................................

Grosstonnage.................................................................................................................

IMOnumber(ifapplicable)................................................................................................
IdeclarethattheantifoulingsystemusedonthisshipcomplieswithAnnex1ofthe
Convention.
.......................................................................................................
(Date) (Signatureofownerorowner'sauthorized
agent)

Endorsementofantifoulingsystem(s)applied
Type(s)ofantifoulingsystems(s)usedanddate(s)of
application..........................................
.....................................................................................................................................
.......................................................................................................
(Date)(Signatureofownerorowner'sauthorized
agent)

Type(s)ofantifoulingsystem(s)usedanddate(s)of
application............................................
.....................................................................................................................................

.......................................................................................................
(Date)(Signatureofownerorowner'sauthorized
agent)
Type(s)ofantifoulingsystem(s)usedanddate(s)of
Disclaimer Althoughapplication............................................
all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register of Shipping is not
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service. 4/5
.....................................................................................................................................
 (Date)(Signatureofownerorowner'sauthorized
agent)
Type(s)ofantifoulingsystem(s)usedanddate(s)of
application............................................
.....................................................................................................................................

.......................................................................................................
(Date)(Signatureofownerorowner'sauthorized
agent)

ER
ST
GI
RE
AN
RE
KO

Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register of Shipping is not
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service. 5/5