AD NO.

: 29-00 REPUBLIC OF THE PHILIPPINES

Initial Issue Date: 09-08-2017
Revision Date: 00
DEPARTMENT OF TRANSPORTATION
MARITIME INDUSTRY AUTHORITY EVALUATION CHECKLIST FOR THE
ACCREDITATION OF PRACTICAL
(GMDSS) ANNEX 3 – SUMMARY OF OBSERVATIONS for the use of ASSESSMENT CENTER
Evaluators (Accreditation Division and BOMDO)

Name of Company or Corporation: Contact Number: Company Address:

Date & Time Commenced of Inspection: Date & Time Completed Inspection:

Company Email : MARINA Control Number:

Initial Inspection Date: Final Inspection Date:

ITEM NO. OBSERVATIONS REMARKS

ANNEX I GENERAL INFORMATION

ANNEX II GMDSS

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AD NO.: 29-00 REPUBLIC OF THE PHILIPPINES
Initial Issue Date: 09-08-2017
Revision Date: 00
DEPARTMENT OF TRANSPORTATION
MARITIME INDUSTRY AUTHORITY EVALUATION CHECKLIST FOR THE
ACCREDITATION OF PRACTICAL
(GMDSS) ANNEX 3 – SUMMARY OF OBSERVATIONS for the use of ASSESSMENT CENTER
Evaluators (Accreditation Division and BOMDO)

ANNEX IV SCENARIO

EVALUATED BY:

___________________________ ___________________________ ___________________________

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Team Leader BOMDO / BOMEO BOMDO / BOMEO

Team Members:

___________________________ ___________________________ ___________________________

(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)

CONFORME:

__________________________________________
Signature Over Printed Name
Company Representative

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