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PRC-MDO Form No. 5Rev.

01/11-04-2000
Republic of the Philippines
PROFESSIONAL REGULATION 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 ___________________________________________ had actually served
underoursupervision on board
__________________________,___________________of_____________________________ (Name
of Vessel) (Type of Vessel) (State theNationality of Vessel)with Registry
No.:_____________which is a______________________ vessel of _______________ gross
tonnage(Near Coastal/ Seagoing)for a period of
_______________________________from_______________________ to
_____________________ (No. of Years) (Months) (Days) (Date of Embarkation) (Date
of Discharge)as______________________.(Position Held)
This certifies further that the above-stated data are all true and that any
falsestatement/s made therein shall be a ground for criminal prosecution.
Issued this_____________day of_______________20_____at_____________________________
SUBSCRIBED AND SWORN TO before me this______ day of___________________,
20____,at_________________.
Doc. No.:___________ Page No.:___________ Book No.:___________ Series of:___________
Note: This form is
good only for one (1) vessel.
This form can be
reproduced.Anyerasure/ obliteration may be a ground for denial.

ALBERT C. PRTUGALSS TRINITY GLORYLNG CARRIERPANAMA4020309SEAGOING111,12601O O118 MARCH 200919 JANUARY 2010ORDINARY
SEAMANJANUARY1910 PYONGTAEK, KOREA
NOT FOR SALE
SEAL OF VESSEL
_

CAPT

.
DENIS VOCUVIK

Master - Signature Above Printed NameNationality: _

_COATIAN_____

_ Kind of License:

MASTER MARINER___ Registration No.: _ __ ________ Date of Registration:

__ Expiry Date:

___
SEAL OF COMPANY

___________________________________________ Name and Signature of Port Captain/


PersonnelMgr. ____________________________________________ Name of Local Shipowner
or Manning AgentAddress:
____________________________________ ____________________________________ Telephone
Nos. ______________________________
________________NOTARY PUBLIC
Mr. Michaelangelo MalanaOSM Maritime Services
VNP Bldg. 479 Pedro Gil St.Ermita, Manila(02) 523-8871