(Official seal of issuing authority.)

(Certificate No. ______)

Issued under the provisions of the International Convention on Load Lines, 1966, under the authority of the Government of the United States of America, and the Commandant, U.S. Coast Guard:

By

and duly authorized for assigning purposes under the provisions of the Convention.

The upper edge of the deck line from which these freeboards are measured is ____ inches above or below the top of the ____ deck at side; i.e., freeboard 1 deck.

Date of initial or periodical survey ________________

This is to certify that this ship has been surveyed and that the freeboards have been assigned and load lines shown above have been marked in accordance with the International Convention on Load Lines, 1966.

This certificate is valid until ________, 2 subject to annual surveys in accordance with Article 14(1)(c) of the Convention, and endorsement thereof on the reverse side of the certificate.

Issued at __________________ (Place of issue of certificate), ____________________, 19____ (Date of issue)

The undersigned declares that he is duly authorized by the said Government to issue this certificate.

1. When a ship departs from a port situated on a river or inland waters, deeper loading shall be permitted corresponding to the weight of fuel and all other materials required for consumption between the point of departure and the sea.

2. When a ship is in fresh water of unit density, the appropriate load line may be submerged by the amount of the fresh water allowance shown above. Where the density is other than unity, an allowance shall be made proportional to the difference between 1.025 and the actual density.

3. It is the owner's responsibility to furnish the master with information and instructions for loading and ballasting this vessel to provide guidance as to stability of the vessel under varying conditions of service and to avoid unacceptable stresses in the vessel's structure.

1 The issuing authority is authorized to delete or change words whenever it is inapplicable to a specific vessel and to arrange wording so appropriate word insertions may be made, which accurately describe the facts.

2 At the expiration of this certificate, applicable reissuance should be obtained in accordance with the Load Line Regulations.

This is to certify that at an annual survey required by Article 14(1)(c) of the Convention, this ship was found to comply with the relevant provisions of the Convention.

4. The Winter North Atlantic Load Line applies only to vessels of 328 feet in length or less, which enter any part of the North Atlantic Ocean during the winter months as defined by the Load Line Regulations in 46 CFR 42.30-5 and 42.30-35. The periods during which the other seasonal load lines apply in different parts of the world are as stated in the Load Line Regulations in 46 CFR 42.30-5 to 42.30-30, inclusive.

5. The Load Line Certificate will be canceled by the Commandant, U.S. Coast Guard, if:

(a) The annual surveys have not been carried out within 3 months either way of each anniversary of the certificate date.

(b) The certificate is not endorsed to show that the ship has been surveyed as indicated in (a).

(c) Material alterations have been made to the hull or superstructure of the vessel, such as would necessitate the assignment of an increased freeboard.

(d) The fittings and appliances for the protection of the openings, guardrails, freeing ports, or the means of access to the crew's quarters have not been maintained in as effective a condition as they were when the certificate was issued.

(e) The structural strength of the ship is lowered to such an extent that the ship is unsafe.

6. When this certificate has expired or has been canceled, it must be delivered to the issuing authority.

The upper edge of the deck line from which these freeboards are measured is ____ inches above or below the top of the ________ deck at side; i.e., freeboard 1 deck.

1 The issuing authority is authorized to delete or change words whenever it is inapplicable to a specific vessel and to arrange wording so appropriate word insertions may be made, which accurately describe the facts.

The timber freeboards given in this certificate are applicable only when this ship carries a timber deck cargo and complies with special requirements of the Load Line Regulations regarding timber deck cargoes.

The upper edge of the deck line from which these freeboards are measured is ____ inches above or below the top of the ________ deck at side; i.e., freeboard 1 deck.

1 The issuing authority is authorized to delete or change words whenever it is inapplicable to a specific vessel and to arrange wording so appropriate word insertions may be made, which accurately describe the facts.

(Official seal of issuing authority.)

(Certificate No. ____)

Issued under the provisions of the International Convention on Load Lines, 1966, under the authority of the Government of the United States of America, and the Commandant U.S. Coast Guard:

and duly authorized for assigning and exemption purposes under the provisions of the Convention.

This is to certify that the above-mentioned ship is exempted from the provisions of the 1966 Convention, under the authority conferred by Article 6(2), 1 Article 6(4), 1 of the Convention referred to above and that this ship has been surveyed accordingly.

The provisions of the Convention from which the ship is exempted under Article 6(2) are:

The voyage for which exemption is granted under Article 6(4) is:

Conditions, if any, on which the exemption is granted under either Article 6(2) or Article 6(4):

This certificate is valid until ________, 2 subject, where appropriate, to annual surveys in accordance with Article 14(1)(c) of the Convention, and endorsement thereof on the reverse side of the certificate.

Issued at

The undersigned declares that he is duly authorized by the said Government to issue this certificate.

1 The issuing authority is authorized to delete whichever reference is inapplicable.

2 At the expiration of this certificate, applicable reissuance should be obtained in accordance with the Load Line Regulations, if permitted.

This is to certify that this ship continues to comply with the conditions under which this exemption was granted.

This ship continues to comply with the conditions under which this exemption was granted and the validity of this certificate is, in accordance with Article 19(4)(a) of the Convention, extended until.