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Marine Orders - Part 53: Employment of Crews, Issue 1 (Order No. 2 of 1993)
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Explain section Appendix 1
FORM 1—THE AGREEMENT
Voyage (or voyages) to be undertaken _________________________________________
Description of Ship
Name of ship _________________________________________
Home port/port of registry * _________________________________________
Full name and address of owner/operator * _________________________________________
Terms of agreement
Period the agreement is to be in force _________________________________________
(Set out briefly the rights and obligations of the parties)
Particulars of Seafarer
Full name and personal identification number _________________________________________
Residential address _________________________________________
_________________________________________
Date and place of birth _________________________________________
Capacity in which engaged _________________________________________
Date and place seafarer is to join ship _________________________________________
Amount/rate of wages * _________________________________________
Proper return port _________________________________________
Name and address of person to contact _________________________________________
in case of emergency _________________________________________
_________________________________________
Signed at ____________________________ on____________________________ , 19 _______
______________________________________ _________________________________
* Omit if not applicable
FORM 2—DISCHARGE
Name of ship _________________________________________
Full name and personal identification _________________________________________
Date and place of birth of seafarer _________________________________________
Capacity in which seafarer engaged _________________________________________
Date and place of engagement _________________________________________
Date and place of discharge _________________________________________
Dates and places seafarer became and _________________________________________
Previous section 7.3 Distressed seamen
Next section FORM 1—THE AGREEMENT FORM 1—THE AGREEMENT
Dated ___________________________ , 19_____
_________________________________________
FORM 3—SEAFARER'S ALLOTMENT NOTE
Name of Ship Official No. Home port Description of voyage
Name of Seafarer _________________________________________________________________
Rating _________________________________________________________________
Name _____________________________________________________
Branch to which payment is to be made _______________________________________
Amount of each allotment _______________________________________
Date of first payment _______________________________________
Period between subsequent payments _______________________________________
I, the abovenamed seafarer, hereby make the above stipulations for the allotment and payment of portion of my wages as a seafarer.
Dated this ___________________________ day of _________________________ , 19__________
_____________________________________
I will pay that portion of the seafarer's wage specified above in accordance with the stipulations set out above.
Dated this ___________________________ day of _________________________ , 19__________
_____________________________________
Name of Ship ______________________________________________________
Name of Seafarer ______________________________________________________
Reference No. in agreement ______________________________________________________
Rating ______________________________________________________
Wages
Date wages ceased _________________________
_____ weeks week ________
Statement of deductions $
Date Port Tax deduction Amount ofpayment Total ($)
Total deductions ________
Total deductions ________
Tax payable on balance ________
Amount payable on discharge ________
The above statement is a correct account of earnings and deductions of the above-named seafarer.
________________________________ ____________________________________
(Signature of Master) (Signature of Seafarer)
FORM 5—ACCOUNT OF WAGES OF SEAFARER LEFT ON SHORE
Name of Ship ______________________________________________________
Name of Seafarer ______________________________________________________
Reference No. in agreement ______________________________________________________
Rating ______________________________________________________
Wages
Date wages ceased _________________________
_____ weeks week ________
Statement of deductions $
Date Port Tax deduction Amount ofpayment Total ($)
Total deductions ________
Total deductions ________
Tax payable on balance ________
Balance due to Seafarer ________
Dated this __________________________ day of ______________________________ , 19 ______
___________________________________
This log was delivered to me this __________________ day of ____________________ , 19 ____
______________________________________
(Signature of Proper Authority)
Port of ____________________
PART I—DESCRIPTION OF SHIP
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border-collapse:collapse"><tbody><tr><td style="width:72.6pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><br><span style="font-family:'Arial (W1)', sans-serif">Name of Ship</span></p></td><td colspan="2" style="width:57pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><br><span style="font-family:'Arial (W1)', sans-serif">Official No.</span></p></td><td colspan="3" style="width:64.8pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><br><span style="font-family:'Arial (W1)', sans-serif">Home port</span></p></td><td colspan="2" style="width:108pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif; font-weight:bold">Registered Tonnage</span><br><span style="font-family:'Arial (W1)', sans-serif">Gross</span><span style="width:27.36pt; display:inline-block"> </span><span style="font-family:'Arial (W1)', sans-serif">Net</span></p></td><td colspan="2" style="width:109.7pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Name of Master</span></p></td></tr><tr><td style="width:72.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:57pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:64.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:108pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:72.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:57pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:64.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:108pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:72.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:57pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:64.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:108pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:72.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:57pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:64.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:108pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td colspan="5" style="width:166.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="text-align:center"><span style="font-family:'Arial (W1)', sans-serif; font-weight:bold">Commencement of agreement</span></p></td><td colspan="2" style="width:107.55pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:159.3pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="text-align:center"><span style="font-family:'Arial (W1)', sans-serif; font-weight:bold">Termination of agreement</span></p></td></tr><tr><td colspan="2" style="width:86.6pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Place</span></p></td><td colspan="2" style="width:67.3pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Date</span></p></td><td colspan="3" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Description of voyage</span></p></td><td colspan="2" style="width:74.7pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Place</span></p></td><td style="width:73.8pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif">Date</span></p></td></tr><tr><td colspan="2" style="width:86.6pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:67.3pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:109.7pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:74.7pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:73.8pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td colspan="2" style="width:86.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:67.3pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:74.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:73.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td colspan="2" style="width:86.6pt; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:67.3pt; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="3" style="width:109.7pt; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="2" style="width:74.7pt; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:73.8pt; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr style="height:0pt"><td style="width:83.4pt"></td><td style="width:14pt"></td><td style="width:53.8pt"></td><td style="width:24.3pt"></td><td style="width:2.15pt"></td><td style="width:49.15pt"></td><td style="width:69.2pt"></td><td style="width:49.6pt"></td><td style="width:35.9pt"></td><td style="width:84.6pt"></td></tr></tbody></table>
PART II—POSITIONS OF DECK LINES AND LOAD LINES
Freeboard from deck line Load line Tropical .....mm (inches)(T) ......mm (inches) above (S) Summer .....mm (inches)(S) Upper edge of line through centre of ring Winter .....mm (inches)(W) ......mm (inches) below (S) Winter North Atlantic .....mm (inches)(WNA) ......mm (inches) below (S) Timber tropical .....mm (inches)(LT) ......mm (inches) above (LS) Timber summer .....mm (inches)(LS) ......mm (inches) above (S) Timber winter .....mm (inches)(LW) ......mm (inches) below (LS) Timber winter North Atlantic .....mm (inches)(LWNA) ......mm (inches) below (LS)
Allowance for fresh water for all freeboards other than timber .........mm (inches). For timber freeboards ........mm (inches).
The upper edge of the deck line from which these freeboards are measured is .....mm (inches).........deck at side.
Maximum draught of water in summer .......decimetres (.....feet......inches)
(Signature of Master) (Date of entry)
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PART VIII—RECORD OF INSPECTIONS OF CREW ACCOMMODATION
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border-collapse:collapse"><tbody><tr><td style="width:22.95pt; border-top:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; border-top:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td colspan="4" style="width:138.05pt; border-top:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="border-bottom:0.75pt solid #000000; padding-bottom:1pt; font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif">Particulars of person making the inspection</span></p></td><td style="width:130.95pt; border-top:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:74.25pt; border-top:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:22.95pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Date</span></p></td><td style="width:24.65pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Time</span></p></td><td style="width:24.65pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Name</span></p></td><td style="width:24.65pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Rank</span></p></td><td style="width:24.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Name</span></p></td><td style="width:31.75pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><br><span style="font-family:'Arial (W1)', sans-serif">Rating</span></p></td><td style="width:130.95pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif; letter-spacing:-0.25pt">Particulars of cases where accommodation does not comply with Marine Orders, Part 14</span></p></td><td style="width:74.25pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><br><span style="font-family:'Arial (W1)', sans-serif">Signatures and date of entry</span></p></td></tr><tr><td style="width:22.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:31.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:130.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:74.25pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:22.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:31.75pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:130.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:74.25pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td></tr><tr><td style="width:22.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="formtext" style="font-size:9pt"><span style="font-family:'Arial (W1)', sans-serif"></span></p></td><td style="width:24.6pt; 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FORM 7—REPORT OF THE MASTER OF AN OCCURRENCE
In accordance with sub-section 417(1) of the Navigation Act 1912, I hereby furnish, as a report on an occurrence to which that sub-section applies, a copy of the entry made in the official log-book with respect to the occurrence.
Dated this ___________________________day of_____________________________, 19 ____
________________________________________
________________________________________
at the Port of ____________________________
FORM 8—CERTIFICATE OF SEAFARER'S SERVICE AT SEA
I certify that ___________________________________ (whose year of birth is approximately 19 __ ) appears from official records to have served in the ships specified in the following table in the capacities, and during the periods, so specified.
Name of Ship Official No. Home port Capacity in which seafarer served Date engaged Date discharged Description of voyage
Dated this __________________________ day of______________________________, 19 ____
__________________________________ _____________________________________
(Signature of Superintendent) (Specimen signature of seafarer)
Part Appendix 1 - Marine Orders - Part 53: Employment of Crews, Issue 1 (Order No. 2 of 1993) - Appendix 1 | Zoe