Application for Issuance of Eiapp Certificate of Marpol 73/78 Annex Vi(2008)

APPLICATION FOR ISSUANCE OF EIAPP CERTIFICATE OF MARPOL 73/78 ANNEX VI(2008)

（This sheet is applied to Revised MARPOL ANNEX VI(2008) and NOx Technical Code(2008).）

To NIPPON KAIJI Applicant’s Document No. , Date of Application:

KYOKAI Applicant:（Name and Address）

(ClassNK)

（Contact Personnel with TEL, FAX and E-mail）

Category of
Application / New Reissue Rewrite / Number of
required document / Orig./Copy 1/
Engine Manufacture & Address
＊To be stated on EIAPP certificate. / Engine Manufacture
Address
Information of
Engine Tested
＊In case of Re-issue or Re-write, from a to f shall be written. / a. Category / Engine Family or Engine Group
Parent or Member
b. Name of Engine Family / Group
c. Engine Type
d. Output / kW / e. Speed / rpm
f. Serial Number / g. Test Cycle
h. Date of build
i.  Date of Test
Applied Regulation / Tier I Tier II Tier III Approved Method
（Reg. 13.3） （Reg. 13.4、 （Reg. 13.5.1.1） （Approval or Installation）＊
13.2.2又は13.5.2）＊ ＊：Delete as appropriate
Test Place
＊In case of New / Company’s Name & Address
Contact Personnel (Tel, Fax and E-mail)
Information of
Parent Engine and Installed Ship
＊In case of New and Member Engine / Certificate Number / Date of Issue
Technical File No. and Approval No. / Date of approval
Class (IMO) No. or
Ship Builder / No. / Flag
Information of
Re-issue or Re-write
＊In case of Re-issue or re-write / Certificate Number / Date of Issue
Reason
Information of Modification
＊ In case of Modification / Ship’s Name / Class Number
Date （Plan） / Date of start of work
Contents of Modification
Attached documents / Manufacturing spec. of Engine / Documents for selection of parent engine
Drawings for Engine / Technical File
Documents for material of engine parts / Plan for NOx measurement
Documents for definition of Engine Family/Group / EIAPP certificate
Other：
Shipping/Billing address
＊In cases where the address is different from the applicant