1. Name of Ship апd Official Number, Dеsсгiрtiоп Suгпаmе of Sеаmап
Poгt of Registry, Horse Power апd of
Gross Топпаgе Voyage
G-ЕtlОIl-
."ISС i)NMlUCt!) VA1cNCul
4.2 8-! 8Aeci;LD/II/t
First Name(s) of Sеаmап
t~t-l.С'тr,А Fos
12.01,08,0 ИI IР/12)ь-и5
ЛIV.vОJV
1
I
Date of Епgаgеmепt Place of Епgаgеmепt
Rапk ог RаtiП(1,I
FIITEr<I
I
I
2<.1 , 04 rD1 I IS~u.>о_ЬI
I
No. of Ceгt. (if апу)
Date of Discharge
I
Place of Discharge
~- ._. - _...__ .
I
--
I РI tг f1 ~c)3
Date апd Place of Biгt"
44. r{) 9. 0·1 02.Х.Ь2 vЛ~NА-I
I
I CERTIFY that the аЬоуе paгticulars аге correct апd that the аЬоуе паmеd Sеаmап was
dischargad ассогdiпglу.
ЛЧ тН :5'[Pt6-1i8Е
Dated this day of . ~, +"51{)О-1
Sigпаturе of Sеаmап .
WARNING - Апу person who forges ог frauduJentJy aJters апу Ceгtificate ог Repoгt, ог сору of
а Repoгt, ог who makes use of апу Ceгtificate ог Repoгt, ог сору of а Repoгt, which is forged ог
aJtered ог does not beJong to him, sha// (ог each such offence Ье JiаЫе to fine ог imprisonment, ог
both.
N.B. - ShouJd this Ceгtificate соте into the possession of апу person to whom it does not
Ье/Dпg, it shouJd Ье transmitted to the Rеgistгаг-GепегаJ of Shipping and Seamen, Va//etta, MaJta.
М.S.(С)З5 (see overleaf)

2. - _. __ ...... ::1 .... ~ '.Н ''9,UILO, 111 Lllt: ~Jrt:5enCe ОТ
tПе ::'ПtРРlПg Master)
I hereby certity the following to Ье а true сору of the героГ! made Ьу the Master in respc~ct of
the seaman whose particulars аге given overleaf, discharged before те this day. .
REPORT OF CHARACTER
For Abllty ForGeneral
Conduct
J. GO() ()