船舶リサイクル施設認可書の様式 (DASR)
令和7年5月21日|p.69
左の本文を選ぶと、右側の官報原文画像で該当箇所を照合できます。
APPENDIX 5
FORM OF THE AUTHORIZATION OF SHIP RECYCLING FACILITIES
Document of Authorization to conduct Ship Recycling (DASR) in accordance with the
requirements of the Hong Kong International Convention for the Safe and
Environmentally Sound Recycling of Ships, 2009
Issued under the provision of the Hong Kong International Convention for the Safe and
Environmentally Sound Recycling of Ships, 2009 (hereinafter referred to as "the Convention")
under the authority of the Government of:
(Name of State)
(Full designation of the Competent Authority under the Convention)
Name of Ship Recycling Facility
Distinctive Recycling Company identity No.
Full address of Ship Recycling Facility
Primary contact person
Phone number
E-mail address
Name, address, and contact information of
ownership company,
Working language(s)
This is to verify that the Ship Recycling Facility has implemented management systems,
procedures and techniques in accordance with Chapters 3 and 4 to the Annex to the Convention.
This authorization is valid until ……………… andis and is subject the limitations identified in
the attached supplement.
This authorization is subject to amendment, suspension, withdrawal, or periodic renewal in
accordance with regulation 16 of the Annex to the Convention.
Issued at
(Place of issue of the authorization)
(dd/mm/yyyy) .
(Date of issue) (Signature of duly authorized official issuing the authorization)
(Typed name and title of duly authorized official issuing the authorization)
(Seal or stamp of the authority, as appropriate)
ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL
REACHING THE PORT OF THE SHIP RECYCLING FACILITY FOR A PERIOD OF
GRACE WHERE REGULATION 14.5 APPLIES*
This certificate shall, in accordance with regulation 14.5 of the Annex to the Convention, be
accepted as valid for a single point to point voyage
from the port of. .
to the port ofi in
Signed:
Place:
Date: (dd/mm/yyyy).
(Signature of duly authorized official)
(Seal or stamp of the authority, as appropriate)
This page of the endorsement shall be reproduced and added to the certificate as considered necessar0.00.0
Administration.