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PRC Form Sample

this form is an example of PRC sea service certificate. It is filled up and can only be edited through photo editin softwares

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Jan Riel Hallarsis
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511 views

PRC Form Sample

this form is an example of PRC sea service certificate. It is filled up and can only be edited through photo editin softwares

Uploaded by

Jan Riel Hallarsis
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PRC-MDO Form no. 5 Rev.

01/11-04-2000

NOT FOR SALE

Republic of the Philippines PROFESSIONAL REGULATIONS 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

HALLARSIS, JAN RIEL CHAVEZ


, (Name of Vessel)

had actually served under our

supervision on board of UNITED KINGDOM

MARIANNE KIRK
with Registry no.

OIL/CHEM TANKER (Type of Vessel)

9397456

(State the Nationality of the Vessel)

,a FOREIGN_ (Coastwise/Foreign)

vessel of 9480 KW and 29,955 gross tonnage for a period of from

00

00
(Months) (Days)

01 .

to 01 JULY 2012 as DECK CADET . (Date of Embarkation) (Date of Discharge) (Position Held)

(No. of years)

This further certifies that the above-stated data are all true and that any false statement/s made therein shall be a ground for criminal prosecution. Issued this CALIFORNIA, USA .
SEAL OF VESSEL

01ST

day of

JULY

2012

.at

RICHMOND, SAN FRANCISCO,

CAPT. YANG, SEONGMO


SEAL OF COMPANY Master- Signature above Printed Name Nationality : SOUTH KOREAN Kind of License : 1ST Class Deck Officer (Master) Registration No. : BS-D1-08-0243 Date of Registration: 12-JUN-2008 Expiry Date : 11-JUN-2013

CAPT. BENJAMIN KATIPUNAN . Name & Signature of Port Captain/Personnel Manager MST MARINE SERVICES, (PHILS.), INC. . Name of Local Shipowner or Manning Agent Address: TSM HOUSE, 1747 DIAN STREET . PALANAN, MAKATI CITY PHILIPPINES
Telephone Nos. 551-2808

SUBSCRIBED AND SWORN TO before me this ______day of __________________________, 20_____, at ____________________________. Date :______________________ Page No :______________________ Book No :______________________ Series of:______________________

_________________________ Notary Public

Note: This form is good only for one (1) vessel. This form can be reproduced. All entries must be type written. Any erasures / obliterations may be a ground for denial.

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