ANNEX B

TESTIMONIAL PRO-FORMA

COMMERCIALLY AND PRIVATELY OPERATED YACHTS ANS SAIL TRAININGVESSELS

ENGINEER OFFICER TESTIMONIAL

is to certify that:This

Fu11 x*,* H-Dzr"z.K:t/ ZK. ct.......D.a4fu/

has served on the yacht/sail training vessel*

}rirotorf#dff Length (m

{rz.'), 56;Type of main engines.4,

a"**JJ r p E'6, a?7t .6.t ;. :3

During this period of senrice, the above-named officer served in the followingcapacity(s) (complete as appropriate)

') --)Chief Eneineer ior ..4..... montk I '2'c,-s-'./Second Engineer for .......... months

Engiaeer Watchkeeper for .......... months

The above yacht service ^cluaes ,^d months . . i. . . days of actual sea service time.

,/

B

COMMERCIALLY AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENGINEER OFFICER SEA SERVICE TESTIMONIAL

This is to certify that:-

Full name .,....

Dateor Bi;15 .Zr.:.6...Q..?.... ... pyAMembership No

has served on the yacht / saiEsaisiryreerel* [name]

officiar Number ? e S y'.f .Z . port of Registry .Za* .'2.aal.

Motortg* Lensth fil1.8.....GrossTonsptl . ..23..2 proputsionpowerlkwi ,/a.q.Q.?,u,'

rype or Main Engines aZr* .Z;"". ( (p" otnuriliary Engines ?grr/ruA/J. . . . .

betweenldd/mm/yyt Z,Z i S ...r.Q.2 and <.6 ..,..6.. '..t'A"2

z And

.7He/#wasgranted:.noleaveofabsencenffi'€e*between

. Hel*e is able to converse and write in the English language.

Position on yacht or in owning / managing company

<i$r""oftr

Chief Engineer for. ...months

Second Engineer tor ..,/.. . . . months

EngineerWatchkeeperfor ... months

. . . days of "actualdays at sea"lSeL definition in TRA|NtNG AND CERTIFICATION GUIDANCE - Part 4.1 of MGN 156 (M) or as amended.l

The above yacht service includes ,Z months ,P,/

COIV]MERCiALLY AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENGINEER OFFICER SEA SER.VICE TEST'IMONIAL

-.-..@ . .. *onus . ../- 5-. .. days

............"......months ............ ....9rr"

...................months ................."......... days

> The above yacht service includes -A.

. . . months 6 . days of ,'actual days at5€6" [See definition in TRAINING AND CERTIFICATION GUIDANCE - Part 4.1 of MGN 156 (M) or as amended.]

He/sh was granted:-fiEEEArc:€+ab6erce / leave of absence " o"t,r""n y'.y'O.:Zo//und /.8.: /eFtb / I

HelsE is able to converse and write in the English language.

Name [print] Mt(*tthg-- LVS,{

Position on yacht or in owning / manasing company futAatWZ- Y/e{

Name of ornning /manasing company M:l 9m L1[) {ZW ssS

has served on the yacht ffi.rrei..€ge*r * [name] . ,Z ./. .:; VZ € 4

orriciarNumber 4//6.A Portof Regisl * .G*n.7.Motorg# rengtn@1y'y'...{ Grossrons Wn fi?.".... ProputsionPower to*l /S.fu krype orMain Ensinee,Zx. .2.?/,?eo.ern/.a. rype orAuxitia o=rfi-lay'. C Z ../{Q,&t

rZQ// and /..6. .t. / Q r ZqZ/> During this period of service, he/she served in the following capacity/ies [please complete as appropriate]

Chief Engineer for

Second Engineer for

Engineer Watchkeeper for

N OR VERIFEEATEON SUBMITTEE COULD I.EAD T8 ThIE:GNING OFFICER'S COE

This is to certifu that:-'r';'^i:=,::Y;2"/ A,,/ Zu ". 2o*, Rrpoo / / r r,;a,Dateor Bifth 2f,:/.2'Z ?tZ- pyAMembership No . ' 5 3* ft d

AF€Y

Signed

COMMERCIAL AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENCINEER OFFICER TESTIMONIAL

This is to certify that:

D ate o r,,.n, Z/. 1/5 Z * o r7n,. nt Z. ?- 2 I 6 . .?. . 2 A t

lras served on the yachtisail training vessel* (nu*").....A..5r///. f

Motor/sail* Length f^1..2.8... Cross Tons(eOZ/2,Propulsion Power (kw).4.5.QQ...

Type of Main Engine ,..G.fr-./2..(...rrouof Auxiliary engines..(-QRP.....dA...

B etween 7./A85. ^"a

7./.r .{.f.{During this period of seruice, the above-named officer. served in the following capacity(s)(complete as appropriate)

Chief Engineer for .......... months

Second Engineer fo, ./-Q.months

E ngi neer watchkeepe, to, . /*.Q.Months

The above yacht time includes .5.. month tr/.€.days of actual sea service time.

The above named officer is able to converse and write in the English language.

signed: /.4. m.......Name (Print) . ..9.0 4!-(. ..

Position on yacht or in owning/managing company* Co7 y'';

Name of owning/managing compa "r. .....1ikdf./tr

Fuil Name: ?.o.eal/ .4 D.fr/-///. ... .Rll.C{

COMMERCIAL AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENGINE[R OFTICER TESTIMONIAL

This is to certify that:

Furr Name:.. 2-.e.RKt/...... /. a p U M... . R.l ( (.Dateor,,*n,q//sz 2>**/ (6- C S7/'/;{-has served on the yachvsdt{raining-vesse t* (namd.A.am/.R4.1. .B.e( /z .

Motortffi* Length t^1..3.3 .. cross ton te!.|€.Q.. proputsion power tr.wl..L€6.....

rype of rurrin rnffl, 7).ol*,./-/du.,Zr1ypeof Auxitiary rnsinesZ3 5*/*..rry.....

s"t*""n/.2t/il2.2una./t1to.c nlol^"

During this period of service, the above-.named officer. served in the following capacity(s)

(complete as appropriate)

Chief Engine ",

tr, ..7.... months

Second Engineer for .......... months

Engineer Watchkeeper for ..*..... Months

The above yacht time includes ........ month , ..d....days of actual sea service time'

The above named officer is able to converse and write in the English language.

Signed:

Name (Print) .n 4.,.B.{.RRr

Position on yacht or in om@man-agifi! companyx C.7o..Ar;'...

COMMERCIALLY AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENGINEER OFFICER SEA SERVICE TESTIMONIAL

This is to certify that:-

Fu,name,4a_n/aa/. reA 6 $ E o.Ra/v.Dateor,,nn?*//z/t,5 7has served on the yacht / sail training vessel * [name] .

ornciarNumber ,ZgS333 po.t ot Registry Gt.A .2 n /AA

PYA

Motor / s# Lengt n f^t .?-.7. .+.r. . .Gross Tons tnt ./4.8 . . . Proputsion Power tn*l 24.66 t-SType of Main Ensines ,H./. fS l6V,Zp.oe.n.?ftypeof Auxitiary EnsinesZ:s a{*/r4r:.3Ok*tbetween[dd/mm/yy] X-O,,7 ...r.O. 7 and .J-3....t.. 7 ..1.O.V

appropriatelJ-\

Chief Engineer for .. # ..rn€iaths' ,Oa.2f S

SecondEngineer for ... .months

EngineerWatchkeeperfor ...months

[See definition in TRAINING AND CERTIFICATION GUIDANCE - Part .17 of MGN 156 (M) or as amended.]

He/sQwasgranted:- no leave of absence/ learae+abeeret between Zffi*"nd ........

He/slfrris able to converse and write in the English language.

Signed %E*k* Namerprintr Dald. za.{t4n*position on yacht or in ownins rmaea@/ CnffnZA{

Name orownins/managins company . . .T).trtmfi[f 1"7D, .,. . .r',...../.../..O

" y'Zr--./dr' /s/ooe

'days

COMMERCIALLYANDPRIVATELYOPERATEDYACHTSANDSAILTRAININGVESSELS

ENGINEER OFFICER SEA SERVICE TESTIMONIAL

This is to certifY that:-

Fuu name .4OZIZ,/ 7zc^r 2Dare or ,,nn Zy' ' ,/2:Z Q.e 7

has served on the yacht / saiHre*+irg=rpsg1 *

orficiarNumber 7: / e.o.7 .

Mobrt# Lensth t*t/.Q.;6...Grossrons tgrlla 2'A...ProPulsionPower[kw] 253-<":

d S 5,/d-< Z. . . rype or Auxitiary Ensine

;";;;r"" ",ro, 2? n,,o2^7'

SecondEngineer for ...'months

EngineerWatchkeeperfor ..' months

> The above yacht service includes ' '

is able to converse and write in the English language'

months 7 ' ' daYs of actual 'daYs

/fuAsrlrgrtlyql manasins comPanY *

' '

- -^i,. 1---,- L-'o .u "/u,r".ade-,

at sea.

[See definition in TRAINING AND cERTlFlcATloN GUIDANCE - Part 17 of MGN 156 (M) or as amended']. / ,/.

Hel€&wasgranted:.noleaveofabsencel|"6M*between/q/,^",.6/.v/"vC-/

-/<-s

FI

, fl>*t,tlA*\. c-"t-A

'63so7

Signed

TESTIMONIAL PRO-FORMA

ANNEX B

COMMERCTALLY AND PRIVATELY OPERATED YACHTS ANS SAIL TRAININGVESSELS

ENGINEER OFFICER TESTIMONIAL

This is to certify that:

Fu, Nanre.. .4a.am ^/.

..R.A.ad..?.o.nnA/

Da re o r u,*,,. Z$. .:.,/- Z .:. .. 5 7. . d sr,*?. a lz / 26..2 e: f6.,5 3.o Z

has servecl o. the yacht/sail-rrairriug-vess# ^,

A.)//.m d

berw een./... / .2. D.6,ra/O t ?. t .Od /x fr66 sH 8or{,-s

During this period of service, the above-named officer serrrecl in the f6lion ingcapacity(s) (cornplete as appropriate)

Chief Engine*rfrr...3.... months /O 22r.s'Second Engineer for months

Engineer Watchkeeper for .......... months

-.7' 2 i_Tlre abcrve yacht service irrcltrdes ./... montlrt<{nft-. c-lays of actual sca servicc tirnc.

-'."ru.-Jr:l" * *"""rse and write i, the Engrish ra.guage'

Na nT e (Printl. . . .Sr. .ma,\. . .-C. . tAftD r./tlr.t(

Position ot'r yacht or in owning/rnanaging compar-ry* . ...

Name of owning/rnanaging company* . . . . . . A V i.V. A . . Lf

Yacht/Com

Motor / W Le,gth <^l . .6 . O... Gross r or-,"<st/.Q/ 6. pr,ptr lsion power rtw\2262C--arn.//r-= 3€/z Dr -t'4" iJrt/")) -2t:)7,Type of main engines. .Cd. {.s. . ..rypeof auxliary enginesZ*. f"6- /. 2 €.{. lSS,

COMMERCIALLY AND PRIVATELY OPERATED YACHTS AND SAIL TRAINING VESSELS

ENGINEER OFFICER SEA SERVICE TESTIMONIAL

U-o-4v,/official Number ,Z .3. 3. A . 3 .7 . port of Registry .1ss p. D.e.4/ .

Motortfi** Length lni{.5.Q.....Grossrons[st] .{.A..7...... Proputsion powerfxwl,/.6./Q.

rypeof Main Engines c^/. .3.€a.8..Dt.{rhvpeof A&iliaryEngines .c*/. g 3.o6.fr.(.between[dd/mm/yy] . 2.c...t...€ .t.Q..5. and .2.t...r.".1.'.....t..o.6.

appropriatelL2

Chief Engineer for . ..1.... months

SecondEngineer for ... .months

EngineerWatchkeeperfor ... months

Theaboveyachtserviceincludes .../......months ......* ..daysof actualseaservice time.

[See definition in TRAINING AND CERTIFICATION GUIDANCE - Part 17 of MGN 156 (M) or as amended.]

He/she was granted:- no leave of absence /.ffi . and .

He/she is able to converse and write in the English language.

sisned t4* il*, Name [print] . .(!:t:..M!.r.

Position on yaeht orin:€wni@ {.u.1 . C i-.i.i:*4.

contact ret: .+. !.1?. .it:'.t. .1't 5. .etV .. . . Fax . ...??s,. .7t:t. .S?'.2-..:j.:,/. .

[Please complete these details to enable PYA to cary out verification of sea time.]

FORM PRODUCED FOR MEMBERS OF

THE PROFESSIONAL YACHTSMEN'S ASSOCIATION

Yacht / Company stamp *

f6#ffi@@#+%

* Delete as appropriate Version 3 June 2004

This is to certify that:-

Furname .4O.2/4./\/ Zn.Ct. ? O724NDateor Bi* ?y'../2 .-./.?.5.7. ..... pyA Membership ." 5.3/,fthas served ontheyachtf@* 1name1 df H. $4 /.i 46-

\\\\

\

t*

;:::{!W?#Kffi,::'H. ;p*wfrW

/,*" o -'Y:;I'

,,,,il, Xg'l':" a*7,: ",'

^ ^* "u ",,, "jl ed i n in e i o\\ ow i nE cap aci tY (s)

,'u*""",/-':I:j;" .n" above nar

\ t ";sll;'t'$lff ", mon,hs:ornp\ete

o' -' '- 4. months

a1.isf EnBine* tot j'-

........ r..,or.\rh:

, Seconc! EnBiireer

to' '-- (.,r .....""'l-*"u r*,"eer

(cr .

*".... *"",n ' .r A:VS oi actua\

sea seNice tirne'

il; i"*"::, l-',,*

-. -"::: jj

-::"'t]in'.n*u'*"the above

'*nt u*].,^..

is aL.\e t-o coflverso

th.c abovs

l-ESStrxs,

13nre(Print)'1"' or"rnindrn*^-t:A

posrtron cn Yrc\''t l.^.-* conrpanY

""

\ Narrre of ownindnran

S'?r*ft'o €9s3:€*/4&,u/f " 9e--^.

ANNEXB

TESTIMONIAL PRO-FORMA

COMMERCIALLY AND PRIYATELY OPERATED YACHTS ANS SAIL TRAININGlrESSELS

ENGINEER OEEICER TESTIMONIAL

This is to certify tkat

Fuil lrlame.. .. ZA.ruA. A/. ?a*{.2e2fu/Date or .r*. .27/t /z 2.5-.7.

has served on the yachtlsafr-{ajlggg5x# tt"r*1...../-{ Q//.d

Mctcr/Sail* Length W>y' 6 rnGross Tons(gt) .lp. i..Proputrsicn Power *W,/ffi.Q

rype nf rnain*soo..G. d i; "auxitiaryengines

f^l' t soda**r* /. fi . 5. t A.?ax,a /-(. I .6..J .A L

During this period of service, the above-named officer served in the followingcapacity(si (complete as appropriate)

Chief Engineer f"r.Z.€.. ffi Zyrt

Second Engineer for ...-.....- months

EngineerWatchkeeperfor nnonths

The above yachi serrrice includes .,.Kffrffi ..2 €.days of actual sea service time.

Position on yadlt or in owning/managing compant'

Stamp"

U Zo.L

Name of owning/managing corrrymqf .. .. ..\LqX n... !S- -.

TESTIMONIAL PRO.TORMA

O.N.: 737650

ANNEX B

: , Zi>n/z/\/ o4(5"3r%*6s3ovr r,,,,,Z//sz 2rr.Zo=n. ?B ooL2 szfy't/

,i,, ii,i,,, flZ&fr4f,*W{Coa*r.-rrA Cu*n,*,rn

6 2 o7 Z/2r:Z ./t 48 3"G

COMMERCIALLY AND PRIVATELY OPERATED YACHTS ANS SAILTRAININCVESSELS

ENCINEER OFFTCER TESTIMONIAL

This is to ceriify that:

During this period of service,, the above.named oflicer served in the followingcapacitv(s) (complete as appropriate)

( lrrt'l Ifr:rr.r'r l(rr /O*nDy,

Seond E^giru.* for .......... months

Engineer Watchkecper for .......... months

The above-named rrfficer is abL'to convcrsr'and rt'rite in the Englislt lan65u.rge.

Nameof or,tninl;/ 5 AnigGAre !NT 6(ntn'rtoM I

Yacht/Company Stnmp. -r

tI,

rI,

IlnrernarionalErLt,,*=

CuRrrrrcATE oF WlrcmrcEprNc Srnvrce

Part l: Details of IssuingParty:

Name of Issuing Pexon/Company:

Title / Position:

Address:

Address 2:

Cotmtry / Zip (Postal Code):

Telephone {incl- Country code}:

Facsimile:

Email:

Additional Contact Information:

Part?: Details of Service:

Name ofYacfot

Flag of Yacht / 0fficial Nrmrber:

Engin€ Tfpe(s) mdKW:

Registerad Tcnnage / Registered Lengih:

Capacrty (e-g. Captaiq Mate, OOW,Chief Engineer etc-):

Areas of Operations:

Dates signed on & signed of &omOfficial Crewlist:

Yardtime/standby days

Days at Sea I Total Mileage:

# of Passages < 60nm / >60nm:

# ofPassages > 150 nm:

frGq &r/{,4. , ,,-, 'tororn,

lg:lzr,r,/tg.y

'.,-V764

-43 ?

?-/ CI-2a/3 t s/-so- ZotSDate Sigredon Date SienedAff

Yarddays 4 Stordbydays

Daysa&a ,/8 Toal Nattical Miles

#<60nm #>64 nm

#> I59nmC:\Users\Chief Stew\Documents\OldDocunrants\AUDACIA2009lSfyflCrelv Paperq,orktv{CA+Sedime+form.doc

Page I of2

Taal nightwatchh$urs*n\tfi

rorT)ovza*,, "'an, ?o.- - .-dateofbirrh,Qlit /2 //?52f'ilLegalNamgl.astiFirst Ddy Month Ymr

Country ofbirth, ,4i**dnrn t-t/{ andpassporr# g??i// 93

4E'€

=

InternationalYachtTraining.

CnnrrrrcATn oF WatcrrrrEprNc Srnrrrcn - coNrrNUED

rr,?r?QN 4DIZ/xN ?ff1- "aateorut*nR4l&, ZO/JFull Legal Name, Last / First 'Day Month Year

Part 3: Testimonial of Service:

Please comment:

Individuals Overall Conduct:(Exemplary, Good, Unsatisfactory... )

Experience and Ability:(Application of skills and the capabilitiesrelative to his,/her performance)

Behavior and Sobriety:

Is the individuals first language English?

@lease circle)If No...Can the individual omverse md write inEnglish d a level thd p€rmits safe vesseloperation dcommlmi:ain a sea?

/':\@,

@No

No

I herebl' certi$ tlrt tlc ebor-e r.rcd lls drl1' corphed tle sea sentce as steted above in thecepaciq ol A*tEtf Lrg,*,sueO". : rr&r n1- couerd- hri.g tlb perfud the aboue-namedofficr r-es ir foIl cfrrp of fic dcc\* erghe' ratcl hr rot hs$ tlcr r Z lorn oot of etery' 2{hoars rlile the vesscl rr e44ed L nhird* I Mr mr<r-l* royrEs es dcscrbcd ebove.