Name:

Rank:
Date of Birth:

CERTIFICATES AVAILABILITY ISSUE DATE EXPIRY DATE

PERSONAL
CERTIFICATES
Travel Passport Y ☐ N ☐ NA ☐
Seaman Book Y ☐ N ☐ NA ☐

ACADEMIC
CERTIFICATES
Rating as able Seafarer Deck Y☐ N☐ NA ☐
Rating as able Seafarer Engine Y☐ N☐ NA ☐
Ship’s Welder Y☐ N☐ NA ☐
Proficiency as Electro Technical Y☐ N☐ NA ☐
Seafarer Course
Ship’s Cook course Y ☐ N ☐ NA ☐
Rating Forming Part of a Y ☐ N ☐ NA ☐
Navigational Watch
Rating Forming Part of an Y ☐ N ☐ NA ☐
Engineering Watch
TRAINING
CERTIFICATES
Proficiency in Survival Craft and Y ☐ N ☐ NA ☐
Rescue Boats Other Than Fast
Rescue Boats
Proficiency of Security Awareness Y ☐ N ☐ NA ☐
Training for Seafarers with
Designated Security Duties
Basic Training and Security Y ☐ N ☐ NA ☐
Awareness Certificate
MEDICAL
CERTIFICATES
Medical Report Y☐ N☐ NA ☐
Blood Analysis Y☐ N☐ NA ☐
Maritime Medical Certificate Y☐ N☐ NA ☐
Certificate of Oral Polio Y☐ N☐ NA ☐
Vaccination for International
International Certificate of Y ☐ N ☐ NA ☐
Vaccination
Covid-19 Vaccination Y ☐ N ☐ NA ☐
ENDORSEMENTS
COP Y ☐ N ☐ NA ☐
GMDSS CERTIFICATE Y ☐ N ☐ NA ☐
SECURITY CERTIFICATE Y ☐ N ☐ NA ☐

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