第6号様式(第9条関係) (日本産業規格A列4番)
限定救命艇手適任証書
Certificate of Proficiency as Person Designated for Inflatable Liferaft Operation
1978年の船員の訓練及び資格証明並びに当直の基準に関する国際条約に基づく証明書
Certificate Issued under the Provisions of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended
日本政府は次のとおり証明する。
The Government of Japan certifies the following:
| 証明書の種類 | |
| Proficiency as | |
| Comply with | of the STCW Convention, as amended |
| Limitations applying (IF ANY) | |
| 証書番号 Certificate No. | |
| 交付年月日 Issued on | |
船員ID/Mariner's ID
姓/Surname
(旧姓/Former surname)
名/Given name
生年月日/Date of birth
性別/Sex
国籍/Nationality
本籍/Registered
署名/Signature