Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Marina Annex D

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

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

from _____________________ _______________________ to _____________________________


(No. of Years)(Months)(Days) (Date of Embarkation) (Date of Discharge)
as ________________________.
(Position Held)

This Further Certifies that the above-stated data are true 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 Number : __________________
Date of Registration : __________________
Expiry Date : __________________

Note:

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

You might also like