Prc-Mdo Form 5 Blank

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PRC-MDO Form No. 5 Rev.

01/11-04-2000

NOT FOR SALE Republic of the Philippines PROFESSIONAL REGULATION COMMISION Cagayan de Oro City BOARD OF MARINE DECK OFFICERS

CERTIFICATE OF SEA SERVICE


(All statements herein are subject to verification)

TO THE BOARD OF MARINE DECK OFFICERS:


THIS CERTIFIES that

JOHN R. JAROMAHUM , BULK CARRIER of (Type of Vessel) vessel of

had actually served under our SINGAPORE (State the Nationality of Vessel) 27735 gross tonnage

supervision on board

MV STAR DRIVANGER (Name of Vessel) a

with Registry No.

387775

SEA GOING (Near Coastal/Seagoing) 8 (Months)

for a period of (No. of Years) as 3rd Mate (Position Held)

22 from 4-Feb-99 to (Days) (Date of Embarkation)

26-Oct-99 (Date of Discharge)

This certifies further that the above-stated data are all true and that any false statement/s made

therein shall be a ground for criminal prosecution.

Issued this______day of________________2010 at ________________. SEAL OF VESSEL SEAL OF COMPANY

Mr. Marlon P. Trinidad / Fleet Head Name and Signature of Port Captain/ Personnel Mgr Magsaysay Maritime Corporation Name of Local Shipowner or Manning Agent Address: Antonio Bldg., 520 T.M. Kalaw Ermita, Manila Telephone Nos. 526-8888/526-9692/5269724

MasterSignature Above Printed Name Nationality : Kind of License : Registration No. : Date of Registration : Expiry Date :

SUBSCRIBED AND SWORN TO before me this_________day of _________________,2010, at _______________________. Doc. No. Page No. Book No. Series of :__________ :__________ :__________ :__________

NOTARY PUBLIC

Note: This form is good only for (1) Vessel. This form can be reproduced. Any erasure/ obliteration may be a ground for denial.

FOR SALE

under our

f Vessel)

ross tonnage

9 harge)

PRC-MDO Form No. 5 Rev. 01/11-04-2000

NOT FOR SALE Republic of the Philippines PROFESSIONAL REGULATION COMMISION Cagayan de Oro City BOARD OF MARINE DECK OFFICERS

CERTIFICATE OF SEA SERVICE


(All statements herein are subject to verification)

TO THE BOARD OF MARINE DECK OFFICERS:


THIS CERTIFIES that

JOHN R. JAROMAHUM , BULK CARRIER of (Type of Vessel) vessel of

had actually served under our SINGAPORE (State the Nationality of Vessel) 27735 gross tonnage

supervision on board

MV STAR DROTTANGER (Name of Vessel) a

with Registry No.

387776

SEA GOING (Near Coastal/Seagoing) 7 (Months)

for a period of (No. of Years) as 3rd Mate (Position Held)

20 from 5-Feb-00 to (Days) (Date of Embarkation)

25-Sep-00 (Date of Discharge)

This certifies further that the above-stated data are all true and that any false statement/s made

therein shall be a ground for criminal prosecution.

Issued this______day of________________2010 at ________________. SEAL OF VESSEL SEAL OF COMPANY

Mr. Marlon P. Trinidad / Fleet Head Name and Signature of Port Captain/ Personnel Mgr Magsaysay Maritime Corporation Name of Local Shipowner or Manning Agent Address: Antonio Bldg., 520 T.M. Kalaw Ermita, Manila Telephone Nos. 526-8888/526-9692/5269724

MasterSignature Above Printed Name Nationality : Kind of License : Registration No. : Date of Registration : Expiry Date :

SUBSCRIBED AND SWORN TO before me this_________day of _________________,2010, at _______________________. Doc. No. Page No. Book No. Series of :__________ :__________ :__________ :__________

NOTARY PUBLIC

Note: This form is good only for (1) Vessel. This form can be reproduced. Any erasure/ obliteration may be a ground for denial.

FOR SALE

under our

f Vessel)

ross tonnage

00 harge)

PRC-MDO Form No. 5 Rev. 01/11-04-2000

NOT FOR SALE Republic of the Philippines PROFESSIONAL REGULATION COMMISION Cagayan de Oro City BOARD OF MARINE DECK OFFICERS

CERTIFICATE OF SEA SERVICE


(All statements herein are subject to verification)

TO THE BOARD OF MARINE DECK OFFICERS:


THIS CERTIFIES that

had actually served under our , (Name of Vessel) (Type of Vessel) vessel of (Near Coastal/Seagoing) of (State the Nationality of Vessel) gross tonnage

supervision on board

with Registry No.

for a period of (No. of Years) as (Position Held) (Months) (Days)

from

to (Date of Embarkation)

(Date of Discharge)

This certifies further that the above-stated data are all true and that any false statement/s made

therein shall be a ground for criminal prosecution.

Issued this______day of________________2010 at ________________. SEAL OF VESSEL SEAL OF COMPANY

Name and Signature of Port Captain/ Personnel Mgr

Name of Local Shipowner or Manning Agent Address:

MasterSignature Above Printed Name Nationality : Kind of License : Registration No. : Date of Registration : Expiry Date :

Telephone Nos.

SUBSCRIBED AND SWORN TO before me this_________day of _________________,2010, at _______________________. Doc. No. Page No. Book No. Series of :__________ :__________ :__________ :__________

NOTARY PUBLIC

Note: This form is good only for (1) Vessel. This form can be reproduced. Any erasure/ obliteration may be a ground for denial.

OT FOR SALE

ed under our

ty of Vessel) gross tonnage

ischarge)

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