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    Cmo Forms 1

    Uploaded by

    Alpha MirM
    The document contains templates for two certificates: 1) Certificate of Sea Service certifies an individual's position, dates of service, and vessel details for a specific ship. It confirms any false statements could result in prosecution. 2) Certificate of Sea Service from a company lists all sea-going positions held by an individual with a company, including vessel details and dates. It also confirms false statements could result in prosecution. The document also includes a template for an IMO Crew List with fields to record details of all crew members onboard a ship for a specific voyage.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Cmo Forms 1

    Uploaded by

    Alpha MirM
    113 views3 pages
    The document contains templates for two certificates: 1) Certificate of Sea Service certifies an individual's position, dates of service, and vessel details for a specific ship. It confirms any false statements could result in prosecution. 2) Certificate of Sea Service from a company lists all sea-going positions held by an individual with a company, including vessel details and dates. It also confirms false statements could result in prosecution. The document also includes a template for an IMO Crew List with fields to record details of all crew members onboard a ship for a specific voyage.

    Original Title

    CMO-FORMS-1

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    © © All Rights Reserved

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    The document contains templates for two certificates: 1) Certificate of Sea Service certifies an individual's position, dates of service, and vessel details for a specific ship. It confirms any false statements could result in prosecution. 2) Certificate of Sea Service from a company lists all sea-going positions held by an individual with a company, including vessel details and dates. It also confirms false statements could result in prosecution. The document also includes a template for an IMO Crew List with fields to record details of all crew members onboard a ship for a specific voyage.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    113 views3 pages

    Cmo Forms 1

    Uploaded by

    Alpha MirM
    The document contains templates for two certificates: 1) Certificate of Sea Service certifies an individual's position, dates of service, and vessel details for a specific ship. It confirms any false statements could result in prosecution. 2) Certificate of Sea Service from a company lists all sea-going positions held by an individual with a company, including vessel details and dates. It also confirms false statements could result in prosecution. The document also includes a template for an IMO Crew List with fields to record details of all crew members onboard a ship for a specific voyage.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Annex D

    Republic of the Philippines


    Office of the President
    COMMISSION ON HIGHER EDUCATION

    Department of Transportation and Communications


    MARITIME INDUSTRY AUTHORITY

    CERTIFICATE OF SEA SERVICE

    This certifies that had actually served


    under our Supervision onboard _ _ _ _ ___ _____ _, _
    (Name of Vessel) (Type of Vessel)
    of with Registry No. , vessel
    (Vessel Nationality) (Near Coastal/Sea-going)
    of KW and Gross Tonnage for a period of _
    m
    ------------- ----------------
    (No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
    as
    -----------
    (Position Held)

    This further certifies that the above-stated data are true and that any false statement/s
    made herein shall be ground for criminal prosecution.

    Issued this day of at _

    SEAL OF VESSEL

    Master - Signature above Printed Name


    Nationality
    Kind of License
    Registration No.
    Date of Registration
    Expiry Date

    Note:

    This form is good only for one (1) vessel. This form can be reproduced. Any erasure/ obliteration
    may be a ground for denial.
    Annex E

    Republic of the Philippines


    Office of the President
    COMMISSION ON HIGHER EDUCATION

    Department of Transportation and Communications


    MARITIME INDUSTRY AUTHORITY

    CERTIFICATE OF SEA SERVICE

    Sir/ Madam :

    This is to certify that holder of SIRB No. has


    been employed by this company with the following sea going service/s:

    Name of Type IMO No. Route Gross KW Registry Period Covered Position/ Total
    Vessel / Official (Foreign / Tonnage Power From To Rank Sea
    No. Domestic) Y/M/D Y/M/D Service
    Y-M-D

    This further certifies that the above-stated data are true and that any false statement/s made herein
    shall be ground for criminal prosecution.

    Issued this day of at _

    COMPANY SEAL
    President/ Duly Authorized Person
    Signature above Printed Name

    SUBSCRIBED AND SWORN to before me this day of , 20_ ,


    at
    --------------
    Doc No.
    Page No.
    Book No. Notary Public
    Series of

    Note:

    This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for
    denial.
    Annex F

    IMO CREW LIST

    n n
    (IMO FAL Form 5)

    I Page Numb e r
    Arrival Departure
    I.I Name of ship I .2 IMO number

    1.3 Call sign I .4 Voyage number

    2. Port of arrival/departu re 3. Date of arrival/departure

    4. Flag State of ship 5. Last port of call

    10 . Date and I I . Nature and number of


    6. No. 7. Family name, given names 8. Rank or rating 9. Nationality place of birth identity document

    12 . Date and signature by master , authorized agent or officer

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