VESSEL

FLAG

DATE
LOCATION

SEAFARER’S NAME
SEAFARER’S RANK

NOTICE OF INVESTIGATION / SHOW CAUSE ORDER

You are hereby informed that you are being charged with having committed the following
offense/s as provided in the POEA Standard Terms and Conditions governing the Employment
of Filipino Seafarers on-board Ocean-Going Ships:

OFFENSE/S (as provided in Section 33 of the PENALTY

POEA Standard Employment Contract)

Due to the following acts:

You are ordered to be present during the investigation, to afford yourself the right to be heard
and to defend against the above-mentioned charges, and to show cause why you should not be
penalized for committing the above-described acts. The investigation shall be conducted on:

DATE TIME

MASTER SEAFARER

_______________________________ _______________________________
Signature over printed name Signature over printed name