P.O. Box 5250 Majorstuen
NO-0303 Oslo
Norway
Self-declaration on implemented NOx-reduction measures
This self-declaration is used to verify the measure's effect and costs. Information can be attached if
needed. For measures that require operation to document the effect of the measure, this operation has
to be carried out over 3 or 12 consecutive months with stable operation after the implementation1.This
will form the basis for the final investment support granted. By agreement with the NOx Fund the
subsequent 3 months period can also be reported provided that this will give a more representative
image of the vessel's normal operational situation. For measures with a 3-12 months operational
period the support can be paid stepwise as updated reports are submitted.
For "dual fuel"-ships the operation in Norwegian waters shall be reported to the Fund for a period of
2 years to ensure that the ship is operated with gas over time.
Separate declaration forms has to be filled out for the specification of costs connected to LNG
measures on ships and of the operational profile of engines in hybrid motor systems.
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.
Applicant Information
Company name (alternatively Norwegian representative)
Organisation number
Postal address
Postal code
City
Contact person
E-mail address
Telephone number
Mobile phone number
Name of ship, rig or production unit
The NOx Fund's reference number (cf.
commitment letter)
IMO number (callsign if any)
Financial Figures
Documented expenses, main items and total costs [NOK]
Copies of all invoices for expenses related to the purchase of the installation.
If the costs are dependent of exchange rates, this has to be informed.
1
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 16.03.2015
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Account number for payment of support
Name of the bank
Account number
IBAN number (if a non-Norwegian bank is
used)
SWIFT code (if a non-Norwegian bank is used)
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:
Yearly consumption and emission
Consumed
fuel before
measure
(tonnes/year)
Consumed
fuel after
measure
(tonnes/year)
Consumed
NOx
fuel reduction emission
(tonnes/year) before
measure
(kg/year)
NOx
emissions
after
measure
(kg/year)
NOx
reduction
(kg/year)
Operation subject to
NOx tax
Operation between
installations¹
Total operation
subject to NOx tax
(operation eligible
for support and
other operation)
1.
2.
3.
Applies only to offshore service ships. 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."
Verification of ships/installations with propulsion by LNG (or other alternative energy carrier) is based on reported
consumption of LNG and possible diesel or other energy carriers. This ongoing consumption over time must be
shown through attachments.
Consumption of potential additives that are used for emission purification must also be stated over time in
attachments.
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Signature from responsible applicant at the enterprise
Date:
Name:
Attachments: Receipts of documented expenses.
Measurement certificates that show emission factor with and without emission
reducing technology in operation.
Calculations
Photo of the implemented measure if relevant.
Updated 16.03.2015
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