SAFETY CERTIFICATE

Issued under the provisions of the

Intfrnational Convention for Safety of Life at Sea. Signed at London, 20th January, 1914.

Name of Sliip.

Signal Letters (International Code).

Port of Registry.

Gross Tonnage.

(Name)

I, the undersigned

certify

I. that the above-mentioned ship has been duly surveyed in accordance with the provisions of the International Convention referred to above ;

II. that the survey showed that the ship complied with the requirements of the said Convention as regards :

(1) the hull, watertight subdivision, main and auxiliary boilers and machinery :

Convention. Article 17, and annexed Regulations, Article X.

(To be filled up only on the request of the owner).

Lengths.

Metres.

Equivalent in feet to.

(1) of the ship for which this certificate is issued

(2) of the standard ship (Column C of the Table in

Art. VIII. of the Regulations) the factor of subdivision of which has been employed in the case of the ship for which this certificate is issued.

(2) the boats and life-saving appliances :

boats capable of accommodating

... persons.

life-buoys.

life-jackets.

(?.) Rîidiotelepraph installation

Class and numbers required by

•Articles 33 and 34 • of the said Convention.

Actual class and numbers.

Class of ship :

{ Operators of the 1st Class Number oi" < „ „ 2nd „ ( Certificated Watchers

III. That in all other respects the ship complies with the requirements of the said Convention, so far as those requirements apply thereto.

This certificate is issued under the authority of the Government. It

will remain in force until

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

(Signature)

Issued at

the

day of

In witness whereof the Plenipotentiaries have signed hereafter.

Done at London, the 20th January, 1914.

VON KOERNEK.

SEELIGER.

SCHÛTT.

RIESS.

PAGEL.

SCHRADER

BEHM.

G. FRANCKENSTEIN.

SCHRECKENTHAL.

DUNAY.

E. A. PIERRARD.

CH. LE JEUNE

LOUIS FRANCK

EMIL KROGH.