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This is to confirm that the following lifeboat arrangements have been carried out periodic maintenance
by the undersigned licensed service engineer in accordance with SOLAS Regulation Ⅲ 20.3.2 and MSC.1/Circular 1206
and that these lifeboat arrangements have been found to be fit for purpose.
Name of ship
Type of Ship
Owner / Manager
Shipbuilder/Hull No.
IMO No. Date of Build
Flag Classification
Davit Type
Date of manufacture
Serial No.
Winch Type
Date of manufacture
Serial No.
Date of servicing , Port of servicing
Kind of Servicing Repair Maintenance Annual servicing 5-Yearly Servicing
Last Date of Servicing Last Service Comapny Last Certificate No. & Eng'r Name
Service Company
Confirmed by Captain
Certificate No.
Launching appliance
1. This statement is based on an agreement in the deliberation of the 48th IMO Ship Design and Equipment (DE) subcommittee.
2. See copies of the certificate on the reverse side.