Modelo de documento provisional de cumplimiento

Pages22-22

Page 22

(Sello oficial) (Estado)

Certificado Nº

Expedido en virtud de las disposiciones del CONVENIO INTERNACIONAL PARA LA SEGURIDAD DE LA VIDA HUMANA EN EL MAR, 1974, enmendado

Con la autoridad conferida por el Gobierno de__________________________________________________(nombre del Estado)

por____________________________________________________________________________________________(persona u organización autorizada)

Nombre y dirección de la compañía...

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