Appendix 1B

EXAMPLE OF SEA SERVICE TESTIMONIAL
This form should be used when a deck officer or the master leaves a ship and should be submitted with
any application for an MCA certificate of competency

Company name
SEA SERVICE TESTIMONIAL - DECK OFFICER
Company Address / Contact Details :...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Tel:........................................ Fax:....................................
PART 1 - WATCHKEEPING SERVICE
This is to certify that:
Full Name of Officer:
Date of Birth:
Discharge Book no. or other National I.D.:

.................................................................................
.................................................................................
.................................................................................

has served on:
Name of Vessel:

.................................

Official Number:

...................................

Type of Vessel:

.................................

Gross Tonnage:

....................................

Area of Operation:...............................................................................................................................
from: .......................................................

to: .................................................................

in the capacity of watchkeeping officer under my command. During this period the
above-named officer was in full charge of a navigation watch for not less than..................
hours out of every 24 hours whilst the vessel was engaged on unlimited*/near coastal*
voyages.
In addition, the above-named officer :
(a) regularly carried out other duties in connection with the routine and maintenance of
the ship;*
(b) served as the senior*/junior* of two watchkeeping officers during the following
periods when bridge watches were doubled and at no other times;*
..............................................................................
(c) was granted no leave of absence*
(d)was granted leave of absence as follows*
...............................................................................
(e) served on board the vessel from.......................to......................whilst under refit or in the
final stages of construction. (Such testimonials to be backed up by a detailed description
of the work undertaken.)
* Delete as appropriate

12

13 ... during the period stated..................................................................................... is as follows: Conduct: Experience/ability: Behaviour/sobriety: PART 3 – OFFICIAL ENDORSEMENT Name (in block letters) of Master: .......................................................TESTIMONIAL My report on the service of the above-named officer.............................................. Signature of Master: . Ship’s/Company stamp and date: In exceptional circumstances this testimonial may be signed by a responsible Official of the Company................................PART 2 ..............

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