Annex A

Sea Service Testimonial (*Trainee Electro-technical Officer/Electro-technical

Rating/electrical engineer/electrician/other please state……………………………
………………………………………..…..…)

Company Address/Contact Details

Company Name: ……………………………………………………………………..

Address: ……………………………………………………………………..
……………………………………………………………………..

…………………………………………………………………….

Contact Details: Tel:.............................................Fax: …………………….

E-mail ……………………………

PART 1 – OPERATIONAL SERVICE

This is to certify that:

Full name of Candidate………………………………………………………………….
Date of Birth …………………………………………………………………………….
Discharge Book Number…………………………………………………………………
Has served on:
Name of ship ………………………………….... IMO Number……………………..

From ........................................................ To ................................................(Dates)

Total propulsion power (MCR)…………………………………..kW

Type and make of propelling machinery ………………………………………………….

Type and make of Generators………………………………………………………………

Distribution voltages……………………………………………………………………….

During this period the above-named candidate:

a) Regularly carried out duties in connection assisting in the monitoring and

maintenance of the ships electrical systems
b) Was granted no leave of absence*
c) Was granted leave of absence as follows*:

…………………………………………………………………………………..
*Delete as appropriate

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PART 2 – TESTIMONIAL

My report on the service of the above-named trainee/rating during the period stated, is
as follows:

Ability: …………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

Conduct: ………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………….……

General comments:
…………………………………………………………………………………..

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

OFFICIAL ENDORSEMENT

Name (block letters)

of Chief Engineer
Officer:

Certificate Grade,
Number, Expiry Date,
and Issuing Country:

Signature of Chief
Engineer Officer:

Ship’s/Company
stamp and date:

In exceptional circumstances this testimonial may be signed by a responsible official of

the Company, who holds an engineer officer certificate of competency and has
knowledge of the candidate’s sea experience.

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