Page:United States Statutes at Large Volume 50 Part 2.djvu/368

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TREATIES Exemption certifi- ncte. Form of Exemption Certificate. EXEMPTION CERTIFICATE. (Official Seal.) Issued under the provisions of the INTERNATIONAL CONVENTION FOR SAFETY OF LIFE AT SEA, 1929. Name of Ship. Distinctive Number or Port of Registry. Gross Tonnage. Letters. The I, the undersigned, (Name) Government certify (Name) certify That the above-mentioned ship is under the authority conferred by Article .. .. of the International Convention referred to above exempted from the requirements oft ........... .. . . . . . of the Convention on the voyages . . . . . . ........ . . ... .. to. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. .

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the conditions, if any,on which the exemption certificate is granted. This certificate is issued under the authority of the Government. It will remain in force until Issued at the day of Here follows the seal or signature of the authority entitled to issue this certificate. (Seal.) If signed, the following paragraphis to be added:- The undersigned declares that he is duly authorised by the said Government to issue this certificate. (Signature.) t rt here referne to Artiles and lgutlo speifying particular paragraphs. [Footnote in the orlginal.] Form. (Country.) 1274