Marina Annex D
Marina Annex D
Marina Annex D
This Further Certifies that the above-stated data are true that any false statement/s made herein
shall be ground for criminal prosecution.
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.