P.O. Box 5250 Majorstuen
NO-0303 Oslo
Norway
Form for self-declaration of SCR systems
This form shall be used to verify the effect of the implemented SCR system through 3 or 12 months
respectively, with continuous good operation after the implementation1. This forms the basis for the
final investment support granted. By agreement with the NOx Fund an additional 3 months period may
also be reported if this will give a more representative picture of the vessel's regular operating
situation.
The NOx Fund reserves the right, when found necessary, to utilise AIS data for the relevant vessel to
verify information in the self-declaration regarding the activity level, fuel consumption in traffic eligible
for support and pertaining estimated NOx-reductions where this is available and considered as
appropriate.
Information about the company and vessel/facility
Company name:
Organisation number:
Postal address:
Postal code:
Contact person:
E-mail address:
Telephone number:
Mobile phone number:
Name of ship, rig or production unit:
City:
The NOx Fund’s reference number
(cf. Commitment Letter):
IMO number (call signal if any):
Financial figures
Costs for purchase of SCR system [NOK]:
Please enclose a copy of all invoices for expenses
If the granted support depends on currency exchange rates, please quote the exchange rate
Account number for payment of support
1
Name of the bank:
Account number:
IBAN number (if a non-Norwegian bank is
used):
SWIFT code (if a non-Norwegian bank is used) :
The verification period for self-declaration of SCR-systems was set to 12 months in January 2014 for vessels that are not
operating in regular routes. For vessels with a minimum of 3 months verification period it is important that the chosen period is
representative of the vessel's operation.
Updated 17.03.2015
Page 1 of 3
Information on the applied-for measure – feasibility
Type of measure (supplier, number of engines and their
size, and other information describing the measure):
Installation
finished (date):
Start of regular
operation (date):
Description of contracts for operation in waters subject to NOx tax and regular routes:
Prospective supplementing comments to the operating situation and description of operating
interruption:
Monthly consumption of urea and fuel
The columns below are only for offshore
service vessels²
Operation subject to NOx tax
Year:
Month no.
Urea consumption
with emissions
subject to NOx tax
in Norwegian
waters (litres)¹
Operation between installations in
Norwegian waters not subject to NOx tax
Fuel consumption
with emissions
subject to NOx
tax in Norwegian
waters (tonnes)
Urea consumption
in operation
between offshore
installations
(litres)²
Fuel consumption in
operation between
offshore installations
(tonnes)
1
2
3
4
5
6
7
8
9
10
11
12
TOTAL
1.
2.
litre
tonnes
litre
tonnes
When recalculating the urea's weight into volume, 1.1 kg per litre is used.
The Environmental Agreement (The Environmental Agreement concerning reduction of NOx
emissions for the period 2011-2017) point 4.1, 2nd paragraph:
"When implementing measures on ships, also the effect the measure has on ship operations between permanent
installations at sea within Norway’s economic zone may be credited to the reduction obligations in article 3.2, on the
condition that such shipping is part of shipping that is in its entirety conducted between Norwegian ports, without
docking at a foreign harbour or at permanent installations at sea outside of Norway’s economic zone, i.e. that the
emissions are included in the Norwegian emission inventory."
Updated 17.03.2015
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Annual consumption and emission figures
Consumption
urea (litre/yr)
Consumption
fuel (ton/yr)
NOx emission
before measure
(kg/yr)
NOx emission
after measure
(kg/yr)
NOx
reduction
(kg/yr)
Operation subject
to support
(eligible for
support)
Operation eligible
for support
between offshore
installations¹
Total operation
(operation eligible
for support and
other operation)
1.
Applies only to offshore service ships. See note 2 on the previous page.
Signature from responsible applicant at the enterprise
Date:
Signature:
Attachments:
Copies of all invoices for purchase of urea as well as expenses for the SCR system.
Measurement certificates before and after the SCR system.
Calculations
Photo of the implemented measure.
Updated 17.03.2015
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