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PRC Form

This certificate verifies that [Name] served as [Position] on board the [Nationality] vessel [Vessel Name] for [Number] years and [Number] months and [Number] days. The vessel is [Coastwise/Foreign] and has a gross tonnage of [Tons]. The master of the vessel confirms the details provided are true and any false statements are grounds for criminal prosecution.

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Clariz Ramos- Lumandas
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5K views

PRC Form

This certificate verifies that [Name] served as [Position] on board the [Nationality] vessel [Vessel Name] for [Number] years and [Number] months and [Number] days. The vessel is [Coastwise/Foreign] and has a gross tonnage of [Tons]. The master of the vessel confirms the details provided are true and any false statements are grounds for criminal prosecution.

Uploaded by

Clariz Ramos- Lumandas
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PRC-MDO Form no. 5 (Rev.

00/10/29/98)

NOT FOR SALE


Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION


Manila

BOARD OF MARINE DECK OFFICERS

CERTIFICATE OF SEA SERVICE


(All Statements herein are subject to verification)

TO THE BOARD OF MARINE DECK OFFICERS:


THIS CERTIFIES that (Name of Vessel) of (Steam or Motor) Registry No.: a (Coastwise/Foreign) of gross tons for a period of (No. of years) from (Date of Embarkation) to (Date of Discharge) as (Position Held) (Months) (Days) . . (State the Nationality of the Vessel) vessel with . .

actually served under our supervision on board

This certifies further that the above-stated data are all true and that any false statements made therein shall be a ground for criminal prosecution. Issued at this day of , 20 .

SEAL OF VESSEL

___________________________
SEAL OF COMPANY Master- Signature Above Printed Name Nationality : _______________ Kind of License : _______________ Registration No. : _______________ Date of Registration : _______________ Expiry Date : _______________

________________________________. Name & Signature of Port Captain/Personnel Manager


___________________________________________. Name of Local Shipowner or Manning Agent Address: ____________________________________. ____________________________________________ . Telephone Nos. _______________________________.
Note: This form is good only for one vessel. This form can be reproduced. All entries must be type written. Any erasures/ obliterations may be grounds for denial.

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