Sea Service Testimonial - Deck

THE PYA SEA SERVICE TESTIMONIAL FOR MASTER & DECK OFFICERS (MCA Approved for use in respect of service on commercially and privately operated yachts and sail training vessels)

Part 1 – Service

This is to certify that:

Name Email address Date of birth

has served in CAPACITY of : Master / Chief Mate / OOW / Deckhand

ON BOARD :

Vessel name Flag Official No. Type (M/Y, S/Y, other) Length-metres GT From /date joined: Until/ date signed off: (i.e. on board yacht (please fill in date service) even if still on board)

The above service includes:

Actual Days at Sea: days (vessel leaves port/under way/at anchor associated with a 24-hour passage) Stand-by Service: days (SHOULD NOT EXCEED DAYS AT SEA - waiting for owner, uniformed/ready to depart Max. 14 consecutive days without leaving port) Shipyard Service: days (max. 90 days allowed per application for OOW3000) Watch keeping: (for HOLDERS OF MCA OOW3000 OR days HIGHER ONLY- can be counted on cumulative basis: every 8 hours = 1 day of watch keeping service until the 09/04/15 and every 4 hours= 1 day after 09/04/15)

Leave of absence was granted as follows:

Areas cruised

QP SRB F001 - Rev. : 6 20/09/2017 Page: 1 of 2 THE PYA SEA SERVICE TESTIMONIAL FOR MASTER & DECK OFFICERS (MCA Approved for use in respect of service on commercially and privately operated yachts and sail training vessels) Part 2 – Official endorsement ANY FALSE INFORMATION OR VERIFICATION SUBMITTED COULD LEAD TO THE WITHDRAWAL OF THE SIGNING OFFICER’S CoC

Signature (should not be self-signed or left blank) Name (capitals) Date Capacity Owner / Master / Responsible Person in Management Company If signing as Master:- CoC No. CoC issuing authority If signing as Position Responsible Person Organisation and Address

Tel. EMAIL ADDRESS for E-mail verification purposes (leaving blank will result in delays)

Yacht / Company Stamp

PYA verification Verified by: Date:

QP SRB F001 - Rev. : 6 20/09/2017 Page: 2 of 2