APP-EIAPP(E)

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).
, Date of Application:

To NIPPON KAIJI Applicants Document No.

KYOKAI Applicant: Name and Address
(ClassNK)

Contact Personnel with TEL, FAX and E-mail

Category of
Application

New

Engine Manufacture
& Address
To be stated
EIAPP certificate.

on

Information of
Engine Tested
In case of Re-issue
or Re-write, from a to f
shall be written.

Reissue

Rewrite

Number of
required document

Orig./Copy 1/

Engine Manufacture
Address
a. Category

Engine Familyor
Engine Group
Parent or Member

b. Name of Engine
Family / Group
c. Engine Type
d. Output

kW

f. Serial Number

e. Speed

rpm

g. Test Cycle

h. Date of build
i. Date of Test
Applied Regulation
Test Place
In case of New

Information of
Parent Engine and
Installed Ship
In case of New and
Member Engine

Information of
Re-issue or Re-write
In case of Re-issue
or re-write

Information of
Modification
In case of
Modification

Attached documents

Tier I

Tier II Tier III Approved Method

Reg. 13.3Reg. 13.4Reg. 13.5.1.1Approval or Installation
13.2.2 13.5.2 Delete as appropriate
Companys Name &
Address
Contact Personnel
(Tel, Fax and E-mail)
Certificate Number
Technical File No.
and Approval No.
Class (IMO) No. or
Ship Builder / No.
Certificate Number

In cases where the

address is different
from the applicant

Date of approval
Flag
Date of Issue

Reas
on
Ships Name

Class Number

Date Plan

Date of start of
work

Contents of
Modification
Manufacturing spec. of Engine
Drawings for Engine

Documents for selection of parent engine

Technical File

Documents for material of engineparts

Plan for NOx measurement

Documents for definition of Engine Family/Group

EIAPP certificate

Other
Shipping/Billing
address

Date of Issue