Form Approved

OMB No. 1625-0094

International Certificate of Fitness for the

Carriage of Dangerous Chemicals in Bulk
Issued under the provisions of the

International Code for the Construction and Equipment

of Ships Carrying Dangerous Chemicals in Bulk
(resolutions MSC.176(79) and MEPC.119(52))
[IBC Code]

Under the authority of the Government of the

United States of America
by the UNITED STATES COAST GUARD
Distinctive Ship Type
Name of Ship Number or Letters Port of Registry Gross Tonnage IMO Number*
(Code Paragraph 2.1.2)

Date on which keel was laid or on which the ship was at a similar stage of construction or, (in the case of a converted ship)
date on which conversion to chemical tanker was commenced:

The ship also complies fully with the following amendments to the Code:

The ship is exempted from compliance with the following provisions of the Code:

THIS IS TO CERTIFY:

1 That the ship has been surveyed in accordance with the provisions of section 1.5 of the Code;

2 That the survey showed that the construction and equipment of the ship and the condition thereof are in all respects
satisfactory and that the ship complies with the relevant provisions of the Code;

3 That the ship has been provided with a Manual in accordance with Appendix 4 of Annex II of MARPOL 73/78 as called
for by regulation 14 of Annex II, and that the arrangements and equipment of the ship prescribed in the Manual are in
all respects satisfactory;

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.

The Coast Guard estimates that the average burden for this report is 30 minutes. You may submit any comments concerning the accuracy of this burden estimate
or any suggestions for reducing the burden to: Commandant (CG-3PCV), U.S. Coast Guard, 2100 2nd St, SW, Washington D.C. 20593-0001 or Office of
Management and Budget, Paperwork Reduction Project (1625-0094), Washington, DC 20503.

* In accordance with IMO ship identification number scheme adopted by the Organization by resolution A.600(15).

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 1 of 7

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 4 That the ship meets the requirements for the carriage in bulk of the following products, provided that all relevant
operational provisions of the Code and Annex II of MARPOL 73/78 are observed:
Conditions of Carriage Pollution
Product (tank numbers, etc.) Category

*
Continued on attachment 1, additional signed and dated sheets.
Tank numbers referred to in this list are identified on attachment 2, signed and dated tank plan.

5 That in accordance with 1.4/2.8.2*, the provisions of the Code are modified in respect of the ship in the following
manner:

6 That the ship must be loaded:

*.1 in accordance with the loading conditions provided in the approved loading manual, stamped and dated
and signed by a responsible officer of the Administration, or of an
organization recognized by the Administration;
*.2 in accordance with the loading limitations appended to this Certificate.

Where it is required to load the ship other than in accordance with the above instruction, then the necessary
calculations to justify the proposed loading conditions shall be communicated to the certifying Administration who
may authorize in writing the adoption of the proposed loading condition.**

This Certificate is valid until subject to surveys in accordance with 1.5

of the Code.***

Issued at _______________________________________, ____________________________________

(Place of issue of Certificate) (Date of issue)
The undersigned declares that he is duly authorized by the said Government to issue this Certificate.

(Signature of official issuing the Certificate)

Notes on completion of Certificate:

1 The Certificate can be issued only to ships entitled to fly the flags of States which are Parties to both SOLAS 74 and MARPOL 73/78.

2 Ship type: Any entry under this column must relate to all relevant recommendations, e.g. an entry "Type 2" should mean Type 2 in all respects
prescribed by the code.

3 Products: products listed in chapter 17 of the Code, or which have been evaluated by the Administration in accordance with 1.1.6 of the Code,
shall be listed. In respect of the latter "new" products, any special requirements provisionally prescribed shall be noted.

4 Products: The list of products the ship is suitable to carry shall include the Noxious Liquid Substances of Category Z which are not covered by the
Code and shall be identified as "chapter 18 category Z".

* Delete as appropriate.
** Instead of being incorporated in the Certificate, this text may be appended to the Certificate if duly signed and stamped.
*** Insert the date of expiry as specified by the Administration in accordance with 1.5.6.1 of the Code. The day and the month of this day correspond to
the anniversary date as defined in 1.3.3 of the Code, unless amended in accordance with 1.5.6.8 of the Code.

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 2 of 7

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 ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS
THIS IS TO CERTIFY that, at a survey required by 1.5.2 of the Code, the ship was found to comply
with the relevant provisions of the Code:

Annual Survey: Signed:

(Signature of duly authorized official)

Place:

Date:

Annual*/Intermediate* Survey: Signed:

(Signature of duly authorized official)

Place:

Date:

Annual*/Intermediate* Survey: Signed:

(Signature of duly authorized official)

Place:

Date:

Annual Survey: Signed:

(Signature of duly authorized official)

Place:

Date:

* Delete as appropriate.

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 3 of 7

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 ANNUAL/INTERMEDIATE SURVEY IN ACCORDANCE WITH
PARAGRAPH 1.5.6.8.3

THIS IS TO CERTIFY that, at an annual/intermediate* survey in accordance with paragraph

1.5.6.8.3 of the Code, the ship was found to comply with the relevant provisions of the
Convention:

Signed:
(Signature of duly authorized official)

Place:

Date:

ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR LESS THAN

5 YEARS WHERE PARAGRAPH 1.5.6.3 APPLIES

This ship complies with the relevant provisions of the Convention, and this Certificate shall, in
accordance with paragraph 1.5.6.3 of the Code, be accepted as valid until

Signed:
(Signature of duly authorized official)

Place:

Date:

ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN COMPLETED

AND PARAGRAPH 1.5.6.4 APPLIES

The ship complies with the relevant provisions of the Convention, and this Certificate shall, in
accordance with paragraph 1.5.6.4 of the Code, be accepted as valid until

Signed:
(Signature of duly authorized official)

Place:

Date:

* Delete as appropriate.

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 4 of 7

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 ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL
REACHING THE PORT OF SURVEY OR FOR A PERIOD OF GRACE WHERE
PARAGRAPH 1.5.6.5 OR 1.5.6.6 APPLIES

*
This Certificate shall, in accordance with paragraph 1.5.6.5/1.5.6.6 of the Code, be accepted as valid
until

Signed:
(Signature of duly authorized official)
Place:
Date:

ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE

PARAGRAPH 1.5.6.8 APPLIES

In accordance with paragraph 1.5.6.8 of the Code, the new anniversary date is

Signed:
(Signature of duly authorized official)
Place:
Date:

In accordance with paragraph 1.5.6.8, the new anniversary date is

Signed:
(Signature of duly authorized official)
Place:

Date:

* Delete as appropriate.

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 5 of 7

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 ATTACHMENT 1 TO THE
INTERNATIONAL CERTIFICATE OF FITNESS FOR THE CARRIAGE OF
DANGEROUS CHEMICALS IN BULK
Continued list of products to those specified in section 4, and their conditions of carriage.
Conditions of carriage Pollution
Products (tank numbers, etc.) Category

Date
(as for Certificate) (Signature of official issuing the Certificate
and/or seal of issuing authority)

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 6 of 7

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ATTACHMENT 2 to the International Certificate of Fitness for the Carriage of Dangerous Chemicals in Bulk

TANK PLAN

Cargo Tanks Above/Below Main Deck

Name of ship:
Distinctive number or letters:

BOW

PORT STARBOARD

STERN

Signature of official issuing the certificate and/or

seal of issuing authority

Date of issue

U.S. Dept. of Homeland Security, USCG, CG-5148B (Rev. 08-06) Page 7 of 7

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