5. MODEL OF PRACTICAL EXAMINATION CERTIFICATE U.K.
We, name of the examining body,hereby certify with document number … thatU.K.
1.Current family name(s) of the holderU.K.
2.Current first name(s) of the holderU.K.
3a.Date of birth (dd/mm/yyyy)U.K.
3b.Place of birth (city)U.K.
has passed the practical examination [for obtaining a certificate of qualification as a boatmaster] [and] [for a specific authorisation for sailing with the aid of radar]
on the simulator (name of the simulator), approved by (name of the competent authority).
Place and date of issue
Signature and stamp of the examining body
Instructions: U.K.
Names shall be entered as in the concerned person's ID card or in the concerned person's passport in UNICODE.
If a name is spelled differently in UNICODE and in ASCII, there shall also be a transcription in ASCII in brackets.
Choose the applicable examination and delete the other examination if not applicable.
Characteristics of the certificate: Colour: white background. Format A4 according to ISO 216.