REPUBLICA PORTUGUESA PORTUGUESE REPUBLIC CERTIFICADO MEDICO PARA Manirimos Medical Certificate for Seafarers ‘eens mao eins de x com aarti fads pl TIONS Yrs es pein mii de ce ee min pte rts a pi tea eo a conor com pean en acne or ms omacones ica se rec ee Fri, arena «ce sev de ars are os ets CW, 17) cafe Ends, Crees hoo een ae ap 37015 do ma, / Me xamatons concen acre ak LOMO Gls fr res apa atl Paes nn he ee ‘Autordadis CmpatentesDiregio-Geal de Recursos Naturals, Segurancae Servis Martimos /Dirogdo-Gral da Sade Competent Authortes Directorate-Genera of Naturel Resources, Safty and Mertine Seuces / irectorate-Generl of Heelth |L_ldentificagso do maritime / Seafarer information REMees [SAPS RECS ac aan bomaain] Dara | Naeger ‘Si Grr I ae tena AS [ECOL CES Ferio/renole ii natin snore aaa | VE VT on eG enna erys eR Ja, asy —— ysis de rfl do eras Toy wedi las ara? Kare nian dane of Se fa wae seo healt aman? © Mo/ ne Ii, Declaragio do médico reconhecido / Declaration ofthe recognized medical practitioner iso [nore do Scigo STEW seco Al) / Sight stands i STCW Code ection RAT Tedd ial isa] soc nla sm Ye Qhno Ro Ys ds Coe sift / Safty colar on sn] Yes Oo is [bas otto teed voces coe nt of st oar rit CSTE SES ke= — SES ONa/ no Arla obatra ce Gem Sanor/ Tsing anh rage nr yas ‘Aunllres do visio nacossrios?/ Viol oid requied? I isin] Yes_ Ono No Ati rms do Cio STOW seo IS) Rearing anarisnTCW Cale seten dT), ‘ide suave satfatria/Sotsfotory hearing acuty Pisin / Yes ONT Wo eis prt san Softonic {sin [Yer Onto Ro Il. Avliagdo da aptiddo / Fitness assessment Com bese nas decaragBes do marfim, exames dics e testes de dlagndstco por mim executados, dedaro que o mario se enconta: / On the boxisof the seafore’s personoldeloration, my cial examingion andthe lagnase tet Tests, | declare the safer Sergodeviinnaponte/ | Serio de mar / Sea services Fun Poston: ‘look-out duties Qeconvés/Deck OcimarayCtering Y3ACase des Méauinavengine © Outre/Other aot Ft gure oi iter ou reste / Linton orrstrctins C)Sim/ Yes Qo / Ho Inapto/ Une sin, expecRque/ fs Oto apicével/nor | Severe /its seciy ta pancemeeee ee ee Oieseto/unre ‘ markio ser de dang suscetve esr agrvada plo oatoraTo pt pra osnivo de nar ou de Soa m/v em isco side de outres pessoas a bordo? / Coes the senforer suffer rom any disase lity tobe aggrovted by, Save 2 render hm uf fer sevice rel eo ennger the heath of ether prsons on bad? [ite oiio an coi GOTTA. Oss ane dete Goma) perenne toner" CA /BOAO| Eeitatteny dactaohnunrny CR OI 00.32 Nome do Maio Medial Procioners name ‘Assnatura Bb edea/ eden Ap ioners Signature Vinheta me wo, al cite rota Paces uma. 2G 004 CIA i a}oor Enis et CT de Als Ween] Carbo Eade Ge seve) 7 bsang Aor Samp WF ‘suing Author ESUMEDICA cama Made [ABS — erat de Coben Nason VR Se aS Pinata oe 12 BO nfm gueulinfrmado do conta Gest cortfiado ed das acre, acura Gamo poral ds Seyfo MWB do COdgo STON {centr ha have been informed of the contents ofthis etic nd he hts ek for review i accordance ith perorap of ston Ax of the STEW cose Ric t Assinar do merino / eafores signature