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

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PART 2 - TESTIMONIAL

My report on the service of the above-named officer, during the period stated, is as follows:

Conduct:

Experience/ability:

Behaviour/sobriety:

PART 3 – OFFICIAL ENDORSEMENT

Name (in block letters) of Master: ........................................................................................................

Signature of Master: ...............................................................................................................................

Ship’s/Company stamp and date:

In exceptional circumstances this testimonial may be signed by a responsible Official of

the Company.

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