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Bill C-7

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ANNEX
CERTIFICATE OF INSURANCE OR OTHER FINANCIAL SECURITY IN RESPECT OF CIVIL LIABILITY FOR BUNKER OIL POLLUTION DAMAGE
Issued in accordance with the provisions of article 7 of the International Convention on Civil Liability for Bunker Oil Pollution Damage, 2001
Name of Ship
Distinctive number or letters
IMO Ship Identification Number
Port of registry
Name and full address of the principal place of business of the registered owner





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 7 of the International Convention on Civil Liability for Bunker Oil Pollution Damage, 2001.
Type of Security        
Duration of Security        
Name and address of the insurer(s) and/or guarantor(s)
Name        
Address        
This certificate is valid until        
Issued or certified by the Government of        
        
(Full designation of the State)
OR
The following text should be used when a State Party avails itself of article 7(3)
The present certificate is issued under the authority of the Government of ........ (full designation of the State) by ........ (name of institution or organization)
At         
On         
(Place)
(Date)

......................................

(Signature and Title of issuing or certifying official)
Explanatory Notes:
1.       If desired, the designation of the State may include a reference to the competent public authority of the country where the Certificate is issued.
2.       If the total amount of security has been furnished by more than one source, the amount of each of them should be indicated.
3.       If security is furnished in several forms, these should be enumerated.
4.       The entry “Duration of Security” must stipulate the date on which such security takes effect.
5.       The entry “Address” of the insurer(s) and/or guarantor(s) must indicate the principal place of business of the insurer(s) and/or guarantor(s). If appropriate, the place of business where the insurance or other security is established shall be indicated.
Published under authority of the Speaker of the House of Commons
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