Certificate of 406MHz Satellite EPIRB for Annual Testing

(MSC.1/Circ.1040/Rev.2 as required by SOLAS regulation IV/15.9)

Vessel particulars
Name of Vessel Flag of Vessel MMSI or Call Sign

EPIRB particulars
Model Serial Number Manufacturer

AIS ID of EPIRB 15 or 23 Hexadecimal identification

Inspection items
Item Requirement Result
Installation Should be mounted for float free operation.
Lanyard Should be attached properly, not be tied to vessel and bracket.
Visual checking Should be labeled properly, and has no crack or other damages.
406MHz signal Frequency 406.025MHz ±5KHz
Hexadecimal identification [ ] Same as the label.
Decoded information MMSI [ ］
Signal coding
Same as the number assigned to the ship.
121.5 MHz homing signal Swept modulation tone is heard from the receiver.
AIS Signal [ ] Same as the ID on the label.

mmm
/ yyyy Should not exceed the date.
Battery expiry date
If replaced, perform Shore Based Maintenance (Circ. 1039).
Hydrostatic release sensor / yyyy Should not exceed the date.
mmm
expiry date Tick if renewed.
Last Shore Based mmm
/ yyyy
Maintenance date Not exceed the interval specified by flag administration or 5 years.
Check the result of self-test is satisfactory.
Self-test
Check the result of GNSS self-test is satisfactory.
RLS function Check the status of RLS function
After remounting it in the bracket, be sure that no transmission has been started.
Final check
Set the mode switch to normal position.
Operating instruction Should be kept on board.
checking the presence of pictorial instructions for manual operation visible at the
Pictorial operating instruction
location of the EPIRB.
Approved Service Supplier
（ Stamp）

Tested by (In block letters) Date of test / /

dd mmm yyyy

Signature Place
Note: Test printout to be attached.

Rev.5.0 (Jul. 2022)

Japan Radio Co., Ltd.
1-7-32 Tatsumi, Koto-ku Tokyo 135-0053, Japan
Tel +81-3-5534-7804 Fax +81-3-5534-7805