船舶リサイクル施設に関する証明書（International Ready for Recycling Certificate）
令和7年5月21日|p.68
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Particulars of the Ship Recycling Facility(ies)
Name of Ship Recycling Facility
Distinctive Recycling Company
identity number
Full address
Date of expiry of DASR
This number is based on the Document of Authorization to conduct Ship Recycling (DASR).
Particulars of the Inventory of Hazardous Materials
Inventory of Hazardous Materials identification/verification number:
Note: The Inventory of Hazardous Materials, as required by regulation 5 of the Annex to the
Convention, is an essential part of the International Ready for Recycling Certificate and must
always accompany the International Ready for Recycling Certificate. The Inventory of
Hazardous Materials should be compiled on the basis of the standard format shown in the
guidelines developed by the Organization
Particulars of the Ship Recycling Plan
Ship Recycling Plan identification/verification number:.
Note: The Ship Recycling Plan, as required by regulation 9 of the Annex to the Convention,
is an essential part of the International Ready for Recycling Certificate and must always
accompany the International Ready for Recycling Certificate.
THIS IS TO CERTIFY:
1 that the ship has been surveyed in accordance with regulation 10 of the Annex to the
Convention;
2 that the ship has a valid Inventory of Hazardous Materials in accordance with
regulation 5 of the Annex to the Convention;
3 that the Ship Recycling Plan, as required by regulation 9, properly reflects the
information contained in the Inventory of Hazardous Materials as required by
regulation 5.4 and contains information concerning the establishment, maintenance
and monitoring of Safe-for-entry and Safe-for-hot work conditions; and
4 that the Ship Recycling Facility(ies) where this ship is to be recycled holds a valid
authorization in accordance with the Convention.
This certificate is valid until (dd/mm/yyyy)………………………………………………………………………………………………………………
(Place of issue of certificate)
Issued at
(dd/mm/yyyyy) (Date of issue) (Signature of duly authorized official issuing the certificate)
(Seal or stamp of the authority, as appropriate)