DG CERTIFICATE & IMSBC CODE Date of Classification Survey Application FITNESS CERTIFICATE / Same as above Date of Submission Yard/Hull Shipbuilder Number Same as applicant. DG CERTIFICATE For Japanese flag ships, NK conducts surveys only. ※ Solid Where loaded Cargo Hold No.: Other (Please specify): Dangerous Goods in Class of 4.1 4.2 4.3 5.1 6.1 8 9 Bulk Dangerous Loading restrictions for Specified Cargo (1): Goods (1)Please complete when restrictions apply to loading of specified cargo in order to meet relevant requirements. Other Weather Deck Cargo Hold No.: Other (Please specify): Where loaded Dangerous Goods Class of 1.1-1.6 1.4S 2.1 2.2 Dangerous 2.3( (flammable) (non-flammable)) Goods 3 (all) 3 (liquid: flashpoint (C) below 23 between 23 and 60) (1)Please complete when restrictions 4.1 4.2 4.3( liquid solid) 5.1 5.2 apply to loading of specified cargo in 6.1 (All) order to meet 6.1 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid relevant requirements. 8 (All) 8 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid 9 Loading restrictions for Specified Cargo (1): IMSBC CODE FITNESS CERTIFICATE IMSBC Code Group A cargoes ( with / without restrictions on moisture content of cargoes) Fitness Group C cargoes Certificate Group B cargoes (Please list all cargoes. If insufficient space, please continue on a separate sheet.) Remarks: In cases where it is impossible to submit this form at the same time as the application form, please make sure to submit this form before the submission of any drawings for approval (including maker drawings).
DG CERTIFICATE & IMSBC CODE FITNESS CERTIFICATE Date of Classification Survey Application Date of Submission Same as above / Shipbuilder Same as applicant. Yard/Hull Number DG CERTIFICATE ※ For Japanese flag ships, NK conducts surveys only. Solid Dangerous Goods in Bulk Where loaded Cargo Hold No.: Other (Please specify): Class of Dangerous Goods (1)Please complete when restrictions apply to loading of specified cargo in order to meet relevant requirements. 4.1 4.2 4.3 5.1 6.1 8 9 Loading restrictions for Specified Cargo (1): Other Dangerous Goods Where loaded Weather Deck Cargo Hold No.: Other (Please specify): Class of Dangerous Goods (1)Please complete when restrictions apply to loading of specified cargo in order to meet relevant requirements. 1.1-1.6 1.4S 2.1 2.2 2.3( (flammable) (non-flammable)) 3 (all) 3 (liquid: flashpoint (C) below 23 between 23 and 60) 4.1 4.2 4.3( liquid solid) 5.1 5.2 6.1 (All) 6.1 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid 8 (All) 8 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid 9 Loading restrictions for Specified Cargo (1): IMSBC CODE FITNESS CERTIFICATE IMSBC Code Fitness Certificate Group A cargoes ( with / without restrictions on moisture content of cargoes) Group C cargoes Group B cargoes (Please list all cargoes. If insufficient space, please continue on a separate sheet.) Remarks: In cases where it is impossible to submit this form at the same time as the application form, please make sure to submit this form before the submission of any drawings for approval (including maker drawings).
Form-1A.docx