JRC JCY-1800 - Declaration on Completion of Annual Inspection for S-VDR

15. Annual Inspection
JCY-1800/1850 VDR/S-VDR Installation Guide
176
DOC No. 7ZPJD0387C
15.2. Declaration on completion of annual inspection for S-VDR
DECLARATION ON COMPLETION OF ANNUAL INSPECTION
FOR S-VDR PERFORMANCE TEST
To Date:
Vessel :
(Name)
IMO Number :
3. This is to certify that the annual inspection for the S-VDR on board the captioned vessel has been completed
satisfactorily as follows.
1) Date of Completion of Inspection:
2) Place of Inspection:
3) Name/Model of S-VDR:
4) Serial Number:
5) Manufacturer:
6) Certificate Number of Type approval:
4. The items of performance test have been examined and recorded in accordance with the requirements of SOLAS
V/18.8 and found to be in compliance with the IMO Resolution MSC.163(78) .
□ Annual Inspection Check □ Ship’s Information up-date
□ General Condition □ Verification of the S-VDR Functions
□ Verification of Input Data and Data Stored in the Capsule
(□ Tick as appropriate)
Inspection Company:
Signature of Inspector:
(Name: )