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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) QP SRB F001 - Rev. : 7 16/05/2018 Page: 1 of 2 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: (i.e. on board yacht service) Until/ date signed off: (please fill in date even if still on board) The above service includes: Actual Days at Sea: (vessel leaves port/under way/at anchor associated with a 24-hour passage) days Stand-by Service: (SHOULD NOT EXCEED DAYS AT SEA - waiting for owner, uniformed/ready to depart Max. 14 consecutive days without leaving port) days Shipyard Service: (max. 90 days allowed per application for OOW3000) days Watch keeping: (for HOLDERS OF MCA OOW3000 OR 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) days Leave of absence was granted as follows: Areas cruised 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) QP SRB F001 - Rev. : 7 16/05/2018 Page: 2 of 2 Part 2 – Official endorsement ANY FALSE INFORMATION OR VERIFICATION SUBMITTED COULD LEAD TO THE WITHDRAWAL OF THE SIGNING OFFICER’S CoC IMPORTANT: By signing this testimonial, you agree for your personal details (name, email, CoC number and position) to be passed on to the PYA for the purpose of contacting you to verify that the information provided above is correct. 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 Responsible Person Position Organisation and Address Tel. EMAIL ADDRESS for verification purposes (leaving blank will result in delays) E-mail Yacht / Company Stamp PYA verification Verified by: Date:
