Annex C

Testimonial Pro-forma
Company Name
Deck Testimonial
Commercially and privately operated yachts and sail training vessels
Address:
Phone
Fax
Email

Part 1 Service
This is to certify that in capacity of Master/ Chief Mate/ OOW/ Rating*:
Full name
..
Date of Birth
/./..
Discharge book . or other National I.D
Has served in the yacht/sail training vessel*:
Name

Motor/Sail* Length (m)

Gross Tons (gt)

Official Number

Vessel Type

From

/./..

To

/./..

The above service includes:

Actual Sea Service of
Stand-by Service of
Yard Service of

.. days
.. days

.. days

During the Actual Sea Service the officer was in full charge of a navigational watch for not less than
eight out of every 24 hours whilst the vessel was engaged on voyage giving:
Watchkeeping Service of ...days

Duties and tasks carried out were:

.
.

Leave of absence was granted as follows :

..
..
..

Delete as appropriate
Complete as appropriate or if no time of that type write NIL

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Part 2 Testimonial
My report on the service of the above-named during the period stated is as follows:
Conduct:

Ability:

Part 3 Official endorsement

Signed

..

Name (Print)

..

Position

Master/ Responsible Person*

If Master then

CoC No.:..
Issuing Administration:.

If responsible person

Organisation:
Position in organisation:.

Yacht/ Company Stamp:

Date

/./.

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