Prc Form DAVE

PRC-MEO Form No.5 Rev.01/11-14-2000

Republic of the Philippines PROFESSIONAL REGULATION COMMISSION Manila BOARD OF MARINE DECK OFFICERS

CERTIFICATE OF SEA SERVICE (All statement herein are subject to verification)

TO THE BOARD OF MARINE ENGINEER OFFICERS: OFFICERS: S CERTIFIES that

had actually served under our 

supervision on board

, (name of vessel)

(type of vessel)

a

with Official No.:

of  (state the Nationality of Vessel)

vessel of

KW and

Gross tonnage

(Near coastal/ Seagoing)

,

for a period of  (No. of years)

, (Months)

from (Days)

to (Date of Embarkation)

(Date of Discharge)

.

as (Position Held)

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

Issued this

day of

20

at

.

SEAL OF VESSEL SEAL OF THE COMPANY

Master: Name and Signature of Port Captain / Personnel Mgr.

Signature Above Printed Name

Nationality: Kind of License: Registration No: Date of Registration:

Expiry Date: Name of Local Ship owner or Manning Agent

Address:

Chief Engineer: Telephone Nos.

63- 2-523

88 71

Signature Above Printed Name

Nationality: Kind of License: Registration No: Date of Registration:

Expiry Date:

at Doc.No. Page No. Book No. Series of 

SUBSCRIBED AND SWORN TO before me this .

day of

,20

NOTARY PUBLIC

Note: This form is only good for one vessel. This form can be reproduced. All entries must be typewritten Erasures / alteration may be grounds for denial.

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