Rev. No.

: 1
Ocean Jade Shipping Date : 1st Jan. 14
CMM CHECKLISTS Pre. by : SOT
App. by : DPA

CMM CL 13 CERTIFICATE OF SERVICE Page 1 of 1

Ocean Jade Shipping

# 503, Daelim Bldg. Jungang-Daero, 132beon-gil, 7
Jung-Gu, Busan, Korea
TEL : +82-51-463-9797, FAX : +82-51-463-9798

CERTIFICATE OF SERVICE

This is to certify that Mr. ____________________________ of ______________________

nationality, born on ____________________ (dd/mm/yyyy) in ________________________
of CDC / Passport No. __________ / ________________ has served in
_________________ rank as follows:

Vessel’s Name Port of Registry / Flag

Vessel’s Type Vessel’s Official No.

GRT / DWT _________ / __________ Main Engine Type/Power

Date / Port embarked _________ / __________ Date / Port Disembarked ________ / _____________

Trading Area Duration ____ months and ____ days

Remarks:

………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………..

I hereby certify that all entries herein were made by me (in hand) and are correct, in witness whereof I have at this
date affixed my signature and the vessel’s stamp.

Master’s Name (Block letters) Master’s Signature Vessel’ stamp / Date