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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 OIL POLLUTION DAMAGE
Issued in accordance with the provisions of Article VII of the International Convention on Civil Liability for Oil Pollution Damage, 1992.
Name of ship
Distinctive number or letters
Port of registry
Name and address of 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 VII of the International Convention on Civil Liability for Oil Pollution Damage, 1992.
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)
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.