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附件3：
港口设施保安符合证书
STATEMENT OF COMPLIANCE OF A PORT FACILITY
（套印国徽）
证书编号：
Statement Number:
本证书系根据《国际船舶和港口设施保安规则》B部分的规定签发
Issued under the provisions of Part B of the
INTERNATIONAL CODE FOR THE SECURITY OF SHIPS AHD OF PORT FACILITIES(ISPS CODE)
中华人民共和国
The Government of
港口设施名称：………………………………………………
Name of the Port Facility: ……………………………
港口设施地址：………………………………………………
Address of the Port Facility: …………………………
兹证明，经核验本港口设施符合经修订的《1974年国际海上人命安全公约》第Ⅺ-2章以及《国际船舶和港口设施保安规则》A部分的规定，且本港口设施根据经批准的《港口设施保安计划》操作。该计划在以下方面得到批准（以下填写适于停靠的船舶类型、操作类型、其它活动及相关信息）：
This is to certify that the compliance of this port facility with the provisions of chapter XI-2 and part A of the International Code for the Security of the Ships and of Port Facilities (ISPS Code) has been verified and that this port facility operates in accordance with the approved Port Facility Security Plan. This plan has been approved for the following <specify the types of operations, types of ships or activities or other relevant information>:
本《符合声明》有效期至： ，
但期间未通过核验的，即行失效。
This Statement of Compliance is valid until______ _______,
subject to verifications.
签发地点
Issued at _________________________
(place of issue of the statement)
签发日期 经授权的官员签字
Date of issue____________ (Signature of the duly authorized official issuing the document)
(发证机关盖章或钢印)
