Annex 1, page 18

APPENDIX 1

FORM OF SOX EMISSION COMPLIANCE CERTIFICATE

Badge
or NAME OF ADMINISTRATION
Cipher
SOX EMISSION COMPLIANCE CERTIFICATE

CERTIFICATE OF UNIT APPROVAL FOR EXHAUST GAS CLEANING SYSTEMS

Issued under the provisions of the Protocol of 1997, as amended by resolution MEPC.176(58)
in 2008, to amend the International Convention for the Prevention of Pollution from Ships,
1973, as modified by the Protocol of 1978 related thereto under the authority of the
Government of:

.....................................................................................................................................................
(full designation of the country)

by.................................................................................................................................................
(full designation of the competent person or organization
authorized under the provisions of the Convention)

This is to certify that the exhaust gas cleaning (EGC) unit listed below has been surveyed in
accordance with the requirements of the specifications contained under Scheme A in the
2015 Guidelines for exhaust gas cleaning systems adopted by resolution MEPC.259(68).

This Certificate is valid only for the EGC unit referred to below:

Unit Model/ Serial EGC System Unit and Technical

manufacturer type number Manual approval number

A copy of this Certificate, together with the EGC System Technical Manual, shall be carried
on board the ship fitted with this EGC System unit at all times.

This Certificate is valid for the life of the EGC System unit, subject to surveys in accordance
with section 4.2 of the guidelines and regulation 5 of MARPOL Annex VI, installed in ships
under the authority of this Government.

Issued at ....................................................................................................................................
(place of issue of certificate)

dd/mm/yyyy
........................................................... ............................................................
(date of issue) (signature of duly authorized official
issuing the certificate)

(Seal or Stamp of the authority, as appropriate)

https://edocs.imo.org/Final Documents/English/MEPC 68-21-ADD.1 (E).doc