PRC-MDO Form No.

5
Rev.01/11-04-2000 Republic of the Philippines
PROFESSIONAL REGULATION COMMISSION
TO THE BOARD OF MARINE ENGINEER OFFICERS:
THIS CERTIFIES that had actually served under our
supervision on board ,
(Type of Vessel) (State the Nationality of Vessel)
with Registry No.: a gross tonnage
for a period of
(No. of Years) (Months) (Days)
as .
This certifies further 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 .
SEAL OF VESSEL
Capt. J AN REZ
Master - Signature Above Printed Name
SEAL OF COMPANY Nationality : CZECH REPUBLI C
Kind of License : MASTER OF ALL SHIPS
Registration No. :
Date of Registration :
Expiry Date :
C/E KONECNY, STANI SLAV
C/ENGR. - Signature Above Printed Name
Nationality : CZECH REPUBLI C
Address: Kind of License : C/ENGR. OF ALL SHIPS
Registration No. :
Date of Registration :
Telephone Nos. Expiry Date :
SUBSCRIBED AND SWORN TO before me this , ,
.
Doc. No. :
Page No. :
Book No. :
Series of :
Note: This form is good only for one (1) vessel. This form can be reproduced. All entries must be typewritten.
Any erasures/ alterations may be a grounds for denial.
NOTARY PUBLIC
at
20 day of
Name and Signature of Port Captain/ Personnel Mgr.
STEFAN SCHMI T
Name of Local Shipowner or Manning Agent
DI AMOND-H MARI NE SHI PPI NG AGENCY
18TH day of NOVEMBER 20 12 at ROTTERDAM, NETHERLANDS
BOARD OF MARINE DECK OFFICERS
Manila
ENGI NE CADET
(Position Held)
CERTIFICATE OF SEA SERVICE
(All Statements herein are subject to verification)
from
(Date of Embarkation)
to
726183 24, 245 vessel of SEAGOI NG
00 2 03
(Date of Discharge)
SEPEMBER 15, 2012
DUMAGUI NG, J I REH J OHN PAUL R.
of M/V NI NA-MARI E
(Name of Vessel)
BULK CARRI ER LI BERI A
NOVEMBER 18, 2012
(Near Coastal/ Seagoing)
PRC-MDO Form No.5
Rev.01/11-04-2000 Republic of the Philippines
PROFESSIONAL REGULATION COMMISSION
TO THE BOARD OF MARINE ENGINEER OFFICERS:
THIS CERTIFIES that had actually served under our
supervision on board ,
(Type of Vessel) (State the Nationality of Vessel)
with Registry No.: a vessel of gross tonnage KW
(Near Coastal/ Seagoing)
for a period of 2 / 7 23 / 27
(No. of Years) (Months) (Days)
as .
This certifies further 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 .
SEAL OF VESSEL
SEAL OF COMPANY
Master - Signature Above Printed Name
Nationality :
Kind of License :
Registration No. :
Date of Registration :
Expiry Date :
Address:
6
Telephone Nos. Chief Engineer - Signature Above Printed Name
Nationality :
Kind of License :
Registration No. :
Date of Registration :
Expiry Date :
SUBSCRIBED AND SWORN TO before me this , ,
.
Doc. No. :
Page No. :
Book No. :
Series of :
Note: This form is good only for one (1) vessel. This form can be reproduced. All entries must be typewritten.
Any erasures/ alterations may be a grounds for denial.
Capt.Torbjorn Berg
Norwegian
Master
at Adelaide,Australia 2006
BOARD OF MARINE ENGINEER OFFICERS
Manila
Ronie L.Dayaday
of M.V.Weaver Arrow Gen.Cargo Bahamas
CERTIFICATE OF SEA SERVICE
(All Statements herein are subject to verification)
(Date of Embarkation)
to 14 Sept 05/11 May 06 22 J un 05/15 Sept 05
730584 Seagoing 36,008 11,637
(Date of Discharge)
(Name of Vessel)
11th day of May
4th Eng'r/3rd Eng'r
(Position Held)
from
(632) 812-31-55
Chief Eng'r.Tadeusz Zimnoch
KGJ S Fleet Management Manila,I nc.
6th Flr.Rufino Plaza Bldg.6784 Ayala Ave.
Cor.V.Rufino St.Legaspi Vill.Makati City
Name and Signature of Port Captain/ Personnel Mgr.
Mr.Guy Domino Macapayag
Name of Local Shipowner or Manning Agent
Chief Engineer
Polish
NOTARY PUBLIC
at
20 day of
PRC-MDO Form No.5
Rev.01/11-04-2000 Republic of the Philippines
PROFESSIONAL REGULATION COMMISSION
TO THE BOARD OF MARINE ENGINEER OFFICERS:
THIS CERTIFIES that had actually served under our
supervision on board ,
(Type of Vessel) (State the Nationality of Vessel)
with Registry No.: a vessel of gross tonnage KW
(Near Coastal/ Seagoing)
for a period of
(No. of Years) (Months) (Days)
as .
This certifies further 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 .
SEAL OF VESSEL
SEAL OF COMPANY
Master - Signature Above Printed Name
Nationality :
Kind of License :
Registration No. :
Date of Registration :
Expiry Date :
Address:
Telephone Nos. Chief Engineer - Signature Above Printed Name
Nationality :
Kind of License :
Registration No. :
Date of Registration :
Expiry Date :
Note: This form is good only for one (1) vessel. This form can be reproduced. All entries must be typewritten.
Any erasures/ alterations may be a grounds for denial.
(632) 812-3155
20
KGJ S Fleet Management Manila, I nc.
6th Flr. Rufino Plaza Bldg. 6784 Ayala Ave.
Cor. V. Rufino St, Legaspi Vill. Makati City
Name and Signature of Port Captain/ Personnel Mgr.
Mr. Guy Domino Macapayag
Name of Local Shipowner or Manning Agent
(Name of Vessel)
day of
(Position Held)
from
BOARD OF MARINE ENGINEER OFFICERS
Manila
of
CERTIFICATE OF SEA SERVICE
(All Statements herein are subject to verification)
(Date of Discharge) (Date of Embarkation)
to
at 05