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Nd, PO Box 27006, Wellington 6141. Phone 04 473 0111 SECTION 1 MASTER TO COMPLETE This is to certify that (Full Name) Has served on the commercial vessel (Vessel Name) Overall length (Metres) In the capacity of Under my command I declare: that Sea days were served during the period Signature of Master: / / to Name of Master (print): / / Date: Certificate Held (number & type): SECTION 2 MASTER’S TESTIMONIAL (The master should insert below his remarks as to the character, abi.

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