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THOME

SHIP MANAGEMENT PTE LTDTSM Form No.Title

THOME

SHIP MANAGEMENT PTE LTDTestimonial for Sea ServiceQuality Assurance into the 21st Century and beyond

TSM FormNo. 073

Vessel: Date:

Registry: Ship Type:

I,

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FORMTEXT Master / Chief Engineer of the vessel

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FORMTEXT do hereby certify that

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FORMTEXT served as

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FORMTEXT on the above mentioned vessel from

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FORMTEXT to

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Type of Vessel:

Class of Vessel:

Gross Tonnage:

Length Overall:

Engine Type:

Engine Make:

Engine Power Rating:

Duties:

Ability:

Conduct:

Sobriety :

Remarks:

Master / Chief Engineer

Name(Ships Stamp)

Date

CONTROLLEDRevision: 01 Jan 2014

Approved by DPA/DMR

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CONTROLLEDRevision: 01 Apr 2005

Approved by DPA/DMR

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