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  • Latvian Medical Certificate

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    deniss sumilovs
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    This document is a Latvian seafarer's medical certificate. It contains the seafarer's personal information such as name, date of birth, nationality, and gender. It certifies that the seafarer meets the health standards for vision, hearing, and color vision established in the STCW code. It also confirms the seafarer is fit for duty and not in need of medication while at sea. The certificate is issued by a medical practitioner recognized by the Latvian Maritime Administration and expires on the date listed.

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    This document is a Latvian seafarer's medical certificate. It contains the seafarer's personal information such as name, date of birth, nationality, and gender. It certifies that the seafarer meets the health standards for vision, hearing, and color vision established in the STCW code. It also confirms the seafarer is fit for duty and not in need of medication while at sea. The certificate is issued by a medical practitioner recognized by the Latvian Maritime Administration and expires on the date listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    41 views1 page

    Latvian Medical Certificate

    Uploaded by

    deniss sumilovs
    This document is a Latvian seafarer's medical certificate. It contains the seafarer's personal information such as name, date of birth, nationality, and gender. It certifies that the seafarer meets the health standards for vision, hearing, and color vision established in the STCW code. It also confirms the seafarer is fit for duty and not in need of medication while at sea. The certificate is issued by a medical practitioner recognized by the Latvian Maritime Administration and expires on the date listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Latvij as JПras administrfl cij а Maritime Administration of Latvia

    JU RNIEKA MEDICINISKAIS SE RTIFIKATS Nr.


    SEAFARER,S MEDICAL СЕRТIFIСАТЕ No.

    Vards(-i) Uzvjirds
    (Name(s)) (SurrralTe)

    Piirbaudlts identilikacijas dokuments: ! pase l iП


    (Identiflcation docut-tlent checked: раssрогt / ИЖru**СIЬа iНЖIi-.1:frХН."Тi, No,) п/r/йrliсlt,
    Dzimýanas datums (Date of biПlr) Yalslspiederlba N at iona Ii
    ry) Dzimums (Gепdеr)
    (dd.mm.yyyy) iдl ч 1дlч [J \Trietis п sieviete
    (dd.mtn.yyyy) (Маlе) (Female)

    Dzirde atbilst standartiem, kas noteikti STCW kodeksa A-I/9 iedala


    Неагiпg r-t-teets the standards in section A-I/9 of STCW code) PJa 1yes) Пttе 1lчо;

    Dzirde bez раl-цlIdzеk|iеm ir арmiеriпоýа (Unaided heaTing satisfactory) lllJa (Yes) llNё (No)
    Redzes asums atbilst standartiem. kas noteikti STCW kodeksa A-I/9 ieda|a
    (Visual acuity lTeets standards in sectiorr.A.-Il9 of STCW code) E.la 1Ves; Плче (lчо)

    КrДsu reclze atbilst standartiem, kas noteikti STCW kodeksa A-I/9 ieda|a
    (Соlоur vision meets standards ir-r section A-I/9 of STCW code) Ela(yest Пшс tNot

    Кriisч redzes pёdёjas pEirbaudes datums (Date of tlre last соlоur vision test)
    1фz/1,1lэ[l$ЖЦ
    Bez vesellbas рrоЬlёmiim, kas var saasiniities reisa laikii vai kuru dC! jПrпiеks var k|Пt перiеmёrоts 'f
    savu рiепбkumu pildlýanai vai арdrаudёt citu uz kuýa esoýo реrsопч чеsеlIЬu ],,{.Ia (Yes) l lNё (No)
    (Frее frоm апу medical condition likeiy to Ье aggravated lэу service at sea оr to rепdеr the sеаlhеr unfit f-оr
    such service оr to епdапgеr the health of оthег реrsопs оп Ьоаrd)
    Nepiecieýams lietot medikamentus reisa laika (Needs to take medication duTing service at sea) ПJа(Yеs) Е(с що1
    Рiеmёrоts(-а) navigEcijas sardzes uп почёrоýапаs рiепЕkumu pildlýanai
    (Fit lor navigational watch and look-out duties) Щ/аlvеs) Пл+с (шо)

    Nepiecieýamas brilles чаi kontaktlёcas (Spectacles оr contact lerrses required) Йаffеs) Пltс 1lчо1

    Аt[ilstdаrЬаmlперiеrпёго_jаrпоizsчТtrоttlFiLГогduti rritIrin{delelerrhichdollotapplyt):

    {Ouiokomanda ! maýTnt_9*/komandi П еdiпаýапаsДmапdД ! cits 1поr3СТi)


    У tdeck depanmentl reylTie depanment) tcatering'depalllnel]t) rorlpr"t/specili ll

    VЪsеlТtrаs atbilstrbas iеrоЬейоfimi (рiеmЕrаm, Ipaýu рiепйkumu izpilde, kuýoýanas rajonydn/vai ilgums, kuýa tips)
    (Li mitations оr restrictiorrs on fitness (e.g. specific duties, trading аrеа апd/оr duration, type olship))
    ,Ё
    Ne П Ja (noradit iеrоЬеЙоjчmчs) ,: л ,/

    (No) (Yes (specify limitations ог restrictions)) C"t/l t_k7t,-L


    ArstniecTbas iestДdes
    adrese,
    Vesellbas pEirbaudes datums
    (Date of healtlr exarninatiorl) (dd.mm.1,"vvv) ( dd. tlm.yyyy)
    к.}( CIARD
    Latyia
    {

    Sertifi kiita derlguma tеrmiцý


    oificial stamp)
    (Expiry date of certificate) (dd.mm.yyyy) (dd.mm.yy11,)

    Valsts akciju sabiedrTbas "Latvijas Jiiras administrДcija" JПrпiеku


    reýistra atzItД jtirnieku arsta paraksts чп zrmogý
    J[rnieka paraksts (Signature and stamp of the medical рrасtitiопеr recognized Ьу the Registry
    (SеаfЪгеr's signature) of Seamen of,tlre state stock company "Maritgg g1 of Latvi а" )
    **ýФHt{ffr
    ftбай6ýр{r{q
    ЙлЬ!Цфчtи пк/фýФ
    av{tiФфl, Z.y.
    -/
    dаrЬu jПrпiесТЬ5. Medicinisko sertifikatu чаr арstrТdёt atbilstoýi naciorrarlo поrmаtТчо aktu рrаýТЬаm.

    Medical ceftilicate mау Ье appealecl in accoldance with t]]e national Iegis]ation,

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