Letter of Acknowledgement of Application

The International Convention on Standards of Training and Certification and Watchkeeping for Seafarers, 1978, as amended
Recognition of Certificates (Regulation I/10)

Issued under the authority of the Government of COOK ISLANDS By THE REGISTRAR OF SHIPS

The Government of the Cook Islands acknowledges that the following officer has submitted an application package, along with relevant
supporting documents for obtaining a flag State endorsement attesting to the recognition of his national certificate, under Regulation I/10
of the Convention. Flag endorsement will be awarded after verification of relevant documents in the application package.

Also, it is confirmed that in accordance with Regulation I/10.5 of the Convention, the officer named below is allowed to serve on board a
Cook Islands registered ship in the capacity shown against his name for a period of not exceeding three (3) months from the date of
issue of this acknowledgement letter, provided that the original national certificate of the seafarer is always available on board for
inspection by an Administration Official.

This document is intended to serve the purpose of ‘documentary proof’ as required under Regulation I/4 – 1.1, ‘control procedures’, of
the Convention, when demanded.

Letter of Acknowledgement C-EC-LOA-2909 Name of Ship BINTANG LIBERTY

Certificate Number 1

Seafarer name TOLOSOKHI LASE Capacity Chief Mate

STCW Regulation II/3.5 Certificate number 6201593386M40422

Date of Issue / Revalidation Date 2 Mar 2022 Date of Expiry 2 Mar 2027

Country of Issue REPUBLIC OF

INDONESIA

This document is valid until: 11 Oct 2022 Date of Issue 11 Jul 2022

Place of issue of certificate Rarotonga, Cook Islands

REMARKS:

SIGNATURE Title Deputy Registrar CIDR - 93

Name Tiare Alice

Story

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