Certificate of Insurance or Other Financial Security in Respect of Liability for the Death of and Personal Injury to Passengers

Annex

Certificate
of Insurance or Other Financial Security in Respect of Liability for the Death of and Personal Injury to Passengers

Issued in accordance with the provisions of Article 4bis

of the Athens Convention relating to the Carriage of

Passengers and their Luggage by Sea, 2002,

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 carrier who

actually performs the carriage.

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 4bis of the Athens Convention

relating  to  the  Carriage  of Passengers and their Luggage by Sea,

2002.

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 4bis, paragraph 3:

The present certificate is issued under the

authority of the Government of..................(full designation of

                                                          the State)

by....................(name of institution or organisation)

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.