Lietuvos Respublikos jūrų laivų registre
įregistruotų laivų laivo apsaugos planų
tvirtinimo, laivo apsaugos sistemų tikrinimo ir
Tarptautinio laivo apsaugos liudijimo
išdavimo tvarkos aprašo
8 priedas
(Tarptautinio laivo apsaugos liudijimo forma)
LIETUVOS RESPUBLIKA
REPUBLIC OF LITHUANIA
TARPTAUTINIS LAIVO APSAUGOS LIUDIJIMAS
INTERNATIONAL SHIP SECURITY CERTIFICATE
Išdavė pagal
Issued under the provisions of the
TARPTAUTINIO LAIVŲ IR UOSTO ĮRENGINIŲ (TERMINALŲ) APSAUGOS KODEKSO (ISPS KODEKSO) REIKALAVIMUS
INTERNATIONAL CODE FOR THE SECURITY OF SHIPS AND OF PORT FACILITIES (ISPS CODE)
LIETUVOS RESPUBLIKOS VYRIAUSYBĖS ĮGALIOTA
UNDER THE AUTHORITY OF THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA
LIETUVOS TRANSPORTO SAUGOS ADMINISTRACIJA
BY LITHUANIAN TRANSPORT SAFETY ADMINISTRATION
Laivo pavadinimas ________________________________________________________________________
Name of ship
Šaukinys _______________________________________________________________________________
Distinctive number or letters
Registracijos uostas _______________________________________________________________________
Port of registry
Laivo tipas ______________________________________________________________________________
Type of ship
Bendroji talpa ___________________________________________________________________________
Gross tonnage
TJO numeris ____________________________________________________________________________
IMO Number
Laivybos bendrovės pavadinimas, adresas _____________________________________________________
Name and address of the Company
Laivybos bendrovės identifikavimo numeris ____________________________________________________
Company identification number
ŠIUO DOKUMENTU LIUDIJAMA, kad:
THIS IS TO CERTIFY:
1. Laivo apsaugos sistema ir visa su ja susijusi įranga buvo patikrinta vadovaujantis ISPS kodekso A dalies 19.1 skirsniu / that the security system and any associated security equipment of the ship has been verified in accordance with section 19.1 of part A of the ISPS Code;
2. Patikrinimas parodė, jog laivo apsaugos sistema ir visa su ja susijusi įranga yra visais atžvilgiais patenkinama ir laivas atitinka Konvencijos XI-2 skyriaus ir ISPS kodekso A dalies reikalavimus / that the verification showed that the security system and any associated security equipment of the ship is in all respects satisfactory and that the ship complies with the applicable requirements of chapter XI-2 of the Convention and part A of the ISPS Code;
3. Laive yra patvirtintas laivo apsaugos planas / that the ship is provided with an approved Ship Security Plan.
Pirminio / pakartotinio patikrinimo, kuriuo remiantis išduotas liudijimas, data _________________
Date of initial/renewal verification on which this certificate is based
Šis liudijimas galioja iki ______________________________
This Certificate is valid until
tuo atveju, jeigu bus atliekami patikrinimai pagal ISPS kodekso A dalies 19.1.1 skirsnį.
subject to verifications in accordance with section 19.1.1 of part A of the ISPS Code.
Išduotas ___________________________________________________________
Issued at (išdavimo vieta / place of issue of the Certificate)
Išdavimo data ___________________ __________________________________________________
Date of issue (įgalioto pareigūno parašas / signature of the duly authorized official)
(A. V. / Seal or stamp of issuing authority, as appropriate)
TARPINIO PATIKRINIMO PATVIRTINIMAS
ENDORSEMENT FOR INTERMEDIATE VERIFICATION
PATVIRTINAME, kad, atlikus tarpinį patikrinimą, kurio reikalaujama pagal ISPS kodekso A dalies 19.1.1 skirsnį, buvo nustatyta, jog laivas atitinka Konvencijos XI-2 skyriaus ir atitinkamas ISPS kodekso A dalies nuostatas.
THIS IS TO CERTIFY that at an intermediate verification required by section 19.1.1 of part A of the ISPS Code the ship was found to comply with the relevant provisions of chapter XI-2 of the Convention and part A of the ISPS Code.
Tarpinis patikrinimas Parašas ______________________________
Intermediate verification Signature
Vieta ________________________________
Place
Data _________________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
PAPILDOMŲ PATIKRINIMŲ PATVIRTINIMAS*
ENDORSEMENT FOR ADDITIONAL VERIFICATIONS*
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data _______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
__________________
*Administracija šią liudijimo dalį patikslina, nurodydama, ar ji pavedė atlikti papildomus patikrinimus, numatytus 19.1.1.4 skirsnyje / This part of certificate shall be adapted by the Administration to indicate whether it has established additional verifications as provided for in section 19.1.1.4.
PAPILDOMAS PATIKRINIMAS, ATLIEKAMAS VADOVAUJANTIS ISPS KODEKSO A DALIES 19.3.7.2 SKIRSNIU
ADDITIONAL VERIFICATION IN ACCORDANCE WITH SECTION A/19.3.7.2 OF THE ISPS CODE
PATVIRTINAME, kad, atlikus papildomą patikrinimą, kurio reikalaujama pagal ISPS kodekso A dalies 19.3.7.2 skirsnį, buvo nustatyta, jog laivas visiškai atitinka Konvencijos XI-2 skyriaus ir atitinkamas ISPS kodekso A dalies nuostatas.
THIS IS TO CERTIFY that at an additional verification required by section 19.3.7.2 of part A of ISPS Code the ship was found to comply with the relevant provisions of chapter XI-2 of the Convention and part A of the ISPS Code.
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
LIUDIJIMO GALIOJIMO PRATĘSIMO PATVIRTINIMAS, JEI LIUDIJIMAS GALIOJA TRUMPIAU NEGU 5 METUS, KAI TAIKOMAS ISPS KODEKSO A DALIES 19.3.3 SKIRSNIS
ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR LESS THAN 5 YEARS WHERE SECTION A/19.3.3 OF THE ISPS CODE APPLIES
Laivas atitinka ISPS kodekso A dalies atitinkamas nuostatas, todėl laikoma,
The ship complies with the relevant provisions of part A of ISPS Code, and the Certificate shall
kad liudijimas, vadovaujantis ISPS kodekso A dalies 19.3.3 skirsniu, galioja iki _______________________
in accordance with section 19.3.3 of part A of the ISPS Code, be accepted as valid until
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
PATVIRTINIMAS ATLIKUS PAKARTOTINĮ PATIKRINIMĄ, KAI TAIKOMAS ISPS KODEKSO A DALIES 19.3.4 SKIRSNIS
ENDORSEMENT WHERE THE RENEWAL VERIFICATION HAS BEEN COMPLETED AND SECTION A/19.3.4 OF THE ISPS CODE APPLIES
Laivas atitinka ISPS kodekso A dalies atitinkamas nuostatas, todėl laikoma,
The ship complies with the relevant provisions of part A of ISPS Code, and the Certificate shall,
kad liudijimas, vadovaujantis ISPS kodekso A dalies 19.3.4 skirsniu, galioja iki ________________________
in accordance with section 19.3.4 of part A of the ISPS Code, be accepted as valid until
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
PATVIRTINIMAS, KAD LIUDIJIMO GALIOJIMAS PRATĘSIAMAS LAIKOTARPIUI, KOL BUS PASIEKTAS TIKRINIMO UOSTAS, TAIKANT ISPS KODEKSO A DALIES 19.3.5 SKIRSNĮ, ARBA LENGVATINIAM LAIKOTARPIUI, TAIKANT ISPS KODEKSO A DALIES 19.3.6 SKIRSNĮ
ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL REACHING THE PORT OF VERIFICATION WHERE SECTION A/19.3.5 OF THE ISPS CODE APPLIES OR FOR A PERIOD OF GRACE WHERE SECTION A/19.3.6 OF THE ISPS CODE APPLIES
Vadovaujantis ISPS kodekso A dalies 19.3.5 ar 19.3.6* skirsniais,
This Certificate shall, in accordance with section 19.3.5/19.3.6* of part A of the ISPS Code,
laikoma, kad šis liudijimas galioja iki ________________________________
be accepted as valid until
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
___________
*išbraukti tą, kuris netinka / delete as appropriate.
GALIOJIMO LAIKOTARPIO PABAIGOS DATOS PERKĖLIMO PATVIRTINIMAS, KAI TAIKOMAS ISPS KODEKSO A DALIES 19.3.7.1 SKIRSNIS
ENDORSEMENT FOR ADVANCEMENT OF EXPIRY DATE WHERE SECTION A/19.3.7.1 OF THE ISPS CODE APPLIES
Vadovaujantis ISPS kodekso A dalies 19.3.7.1 skirsniu,
In accordance with section 19.3.7.1 of part A of the ISPS Code,
naujoji galiojimo laikotarpio pabaigos data** yra ________________________
the new expiry date** is
Papildomas patikrinimas Parašas ____________________________
Additional verification Signature
Vieta ______________________________
Place
Data ______________________________
Date
(A. V. / Seal or stamp of issuing authority, as appropriate)
_____________
**Užpildžius šią liudijimo dalį, atitinkamai keičiama liudijimo pirmajame lape nurodyta galiojimo laikotarpio pabaigos data / In case of completion of this part of Certificate, the expiry date shown on the front of the Certificate shall also be amended accordingly.
___________
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Lietuvos Respublikos jūrų laivų registre
įregistruotų laivų laivo apsaugos planų
tvirtinimo, laivo apsaugos sistemų tikrinimo ir
Tarptautinio laivo apsaugos liudijimo
išdavimo tvarkos aprašo
9 priedas
(Laikino tarptautinio laivo apsaugos liudijimo forma)
LIETUVOS RESPUBLIKA
REPUBLIC OF LITHUANIA
LAIKINAS TARPTAUTINIS LAIVO APSAUGOS LIUDIJIMAS
INTERIM INTERNATIONAL SHIP SECURITY CERTIFICATE
Išdavė pagal
Issued under the provisions of the
TARPTAUTINIO LAIVŲ IR UOSTO ĮRENGINIŲ (TERMINALŲ) APSAUGOS KODEKSO (ISPS KODEKSO) REIKALAVIMUS
INTERNATIONAL CODE FOR THE SECURITY OF SHIPS AND OF PORT FACILITIES (ISPS CODE)
LIETUVOS RESPUBLIKOS VYRIAUSYBĖS ĮGALIOTA
UNDER THE AUTHORITY OF THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA
LIETUVOS TRANSPORTO SAUGOS ADMINISTRACIJA
BY LITHUANIAN TRANSPORT SAFETY ADMINISTRATION
Laivo pavadinimas ________________________________________________________________________
Name of ship
Šaukinys _______________________________________________________________________________
Distinctive number or letters
Registracijos uostas _______________________________________________________________________
Port of registry
Laivo tipas ______________________________________________________________________________
Type of ship
Bendroji talpa ___________________________________________________________________________
Gross tonnage
TJO numeris ____________________________________________________________________________
IMO Number
Laivybos bendrovės pavadinimas, adresas _____________________________________________________
Name and address of the Company
Laivybos bendrovės identifikavimo numeris
____________________________________________________
Company identification number
PATVIRTINAME, kad ISPS kodekso A dalies 19.4.2 skirsnio .reikalavimai įvykdyti.
Šis liudijimas išduotas vadovaujantis ISPS kodekso A dalies 19.4 skirsniu.
THIS IS TO CERTIFY that the requirements of section A/19.4.2 of the ISPS Code have been complied with.
This Certificate is issued pursuant to section A/19.4 of the ISPS Code.
Šis liudijimas galioja iki ______________________________
This Certificate is valid until
Išduotas ___________________________________________________________
Issued at (išdavimo vieta / place of issue of the Certificate)
Išdavimo data ___________________ __________________________________________________
Date of issue (įgalioto pareigūno parašas / signature of the duly authorized official)
(A. V. / Seal or stamp of issuing authority, as appropriate)
__________
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