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PRC Form 5 (Engine) Edited
PRC Form 5 (Engine) Edited
01/11-04-2000
Republic of the Philippines PROFFESIONAL REGULATION COMMISION Manila BOARD OF MARINE ENGINEEROFFICERS
had actually served under our of 12,667 April 27, 2011 STOCKHOLM
(State Nationality of Vessel)
M/S FALSTAF,
(Name of Vessel) Which is a
SEAGOING
15
(Days)
vessel of
Kw and to
6
(Months)
from
(Date of Embarkation)
This certifies further that the above-stated data are all true and that any false statement/s made therein shall be ground for criminal prosecution. Issued this 11Th day of November 2011 at YOKOHAMA, JAPAN .
SEAL OF COMPANY Mr. Arsenio de la Pea Jr. Name and Signature of Port Captain/Personnel Mgr SWEDISH CREWING MANAGEMENT Name of Local Ship Owner on Manning Agent Address: 3rd Flr. First Place Maritime 7458 Bagtikan Street, San Antonio Village, Makati City Philippines Telephone Nos.: (02) 898-1149 Fax No. : (02) 898-1148
SEAL OF VESSEL
Master Signature above Printed Name Nationality Kind of License : Registration No. Date of Registration Expiry Date : : :
Nationality : Kind of License : Registration No. : SUBSCRIBE AND SWORN TO before me this ________________ day of ___________________ 2011, Date of Registration : at_______________________________ . . Expiry Date :
Doc. No. Page No. Book No. Series of : ____________ : ____________ : ____________ : ____________
NOTARY PUBLIC