3.MODEL OF SERVICE RECORD BOOK COMBINED WITH CERTIFICATES OF QUALIFICATIONSU.K.
Page 1 of model
Name of country
Flag
Service record book combined with certificates of qualification U.K.
Identification of the holder 2D barcode U.K.
1.Name(s) of the holder:U.K.
2.First name(s):U.K.
3a.Date of birth:U.K.
3b.Place of birth:U.K.
4.Crew member identification number:U.K.
5.PhotoU.K.
Identification of the service record book U.K.
1.Serial number:U.K.
2.Date of issue:U.K.
3.Issuing authority:U.K.
4.Signature and stamp of issuing authority:U.K.
5.Serial number of former service record book:U.K.
Page 2 of model
European Union certificates of qualification and certificates of qualification issued according to the Regulations for Rhine Navigation Personnel as apprentice, deckhand, boatman, able boatman and helmsman U.K.
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Page 3 of model
Other certificates concerning qualifications relevant for inland navigation U.K.
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Fitness related mitigation measures and restrictions:U.K.
Serial number:
Date of issue:
Date of expiry:
Issuing authority:
Signature and stamp of issuing authority:
Page 4 of model
Service time U.K.
Service time on board, name of craft: UNTERWALDEN U.K.
Unique European vessel identification number or other official craft number: 07000281 …
Type of craft (1): …
State of registration: CH …
Length of craft in m*, /number of passengers* 105 m …
Name and address of the owner: …
TSAG, Hauptstrasse 55, CH-4127 Riehen, Basel-Stadt …
Holder assumed service as: 2 …
Holder assumed service on (date): 22.10.1995 …
End of service (date): 22.11.1996 …
/Boatmaster (name and address): …
K. Huber, Rheinstrasse 55, D-76497 Wintersdorf …
Place, date and signature of boatmaster: Rotterdam, 20.11.1996 …
K. Huber …
…
Service time on board, name of craft: …U.K.
Unique European vessel identification number or other official craft number: …
Type of craft …
State of registration: …
Length of craft in m*, /number of passengers* …
Owner (name and address): …
…
Holder assumed service as: …
Holder assumed service on (date): …
End of service (date): …
Boatmaster (name and address): …
Date, place and signature of boatmaster: …
Service time on board, name of craft: …U.K.
Unique European vessel identification number or other official craft number: …
Type of craft: …
State of registration: …
Length of craft in m*, /number of passengers* …
Owner (name and address): …
…
…
(1)For type of craft, always indicate if type C or G tanker, large convoy or if craft using LNG as fuelU.K.
*delete if not applicableU.K.
Holder assumed service as: …
Holder assumed service on (date): …
End of service (date): …
Boatmaster (name and address): …
Date, place and signature of boatmaster: …
Service time on board, name of craft: …U.K.
Unique European vessel identification number or other official craft number: …
Type of craft: …
State of registration: …
Length of craft in m*, /number of passengers*: …
Owner (name and address): …
…
Holder assumed service as: …
Holder assumed service on (date): …
End of service (date): …
Boatmaster (name and address): …
Date, place and signature of boatmaster: …
Pages 5 to 23 as page 4
Page 24 of model
Navigation time and stretches of inland waterways sailed over last 15 months U.K.
The number of days navigated must be coherent with the navigation time entered in the logbook!
| Name of craft or unique European identification number or other official craft number | journey from(km) | via | to(km) | Start of journey (date) | Days of interruption | End of the journey (date) | Total number of navigation days | Signature of boatmaster |
|---|---|---|---|---|---|---|---|---|
| A | B | C | D | E | F | G | ||
| 1 | ||||||||
| 2 | ||||||||
| 3 |
complete document
☐yesU.K.
☐noU.K.
Doubts at line(s) …
Doubts have been eliminated by
☐presentation of (parts of) the logbookU.K.
☐by other official documentsU.K.
…
Headings of columns A to G are not printed on the following pages 25 to 55.
Space reserved for competent authority
| To be completed by authority: Total number of navigation days taken into consideration from this page |
Validation mark of the competent authority
Presented on (date)
Signature and stamp of the authority
Page 25 of model
Navigation time and stretches of inland waterways sailed over last 15 months … Year: 2015/2016 U.K.
The number of days navigated must be coherent with the navigation time entered in the logbook!
Complete document
☐yesU.K.
☐noU.K.
Doubts at line(s)
…
Doubts have been eliminated by presentation of
☐(parts of) the logbookU.K.
☐of other official documentsU.K.
Space reserved for competent authority
| To be completed by authority: Total number of navigation days taken into consideration from this page | 81 |
validation mark of the competent authority
Presented on (date) …
Signature and stamp of the authority
Page 26 of model
Navigation time and stretches of inland waterways sailed over last 15 months … Year: … U.K.
The number of days navigated must be coherent with the navigation time entered in the logbook!
| A | B | C | D | E | F | G |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| 6 | ||||||
| 7 | ||||||
| 8 | ||||||
| 9 | ||||||
| 10 |
Complete document
☐yesU.K.
☐noU.K.
Doubts at line(s)
…
Doubts have been eliminated by presentation of
☐(parts of) the logbookU.K.
☐of other official documentsU.K.
Space reserved for competent authority
| To be completed by authority: Total number of navigation days taken into consideration from this page |
validation mark of the competent authority
Presented on (date) …
Signature and stamp of the authority
Pages 27 to 55 as page 26
Instructions for the issuing authorities U.K.
Identification of the holder U.K.
1.Current family name(s) of the holderU.K.
2.Current first name(s) of the holderU.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.
3a.Date of birth (dd/mm/yyyy)U.K.
3b.Place of birth (city)U.K.
4.Crew member identification number of the holder as attributed in the database referred to in Art. 25(2) of Directive (EU) 2017/2397 of the European Parliament and of the Council (1),U.K.
Identification of the SRB U.K.
1.The serial number of the service record book shall be repeated in the lower section of each page.U.K.
Certificates of qualification U.K.
2.The title of the issued certificate shall be inserted (in caps font) by the relevant competent authority. It shall be complemented by the following relevant number in brackets: ‘(2)’ for Helmsman, ‘(3)’ for Able boatman, ‘( 4)’ for Boatman, ‘(5)’ for Deckhand and ‘(6)’ for Apprentice.U.K.
As regards the Union certificates of qualifications, the title ‘European Union certificate of qualification in inland navigation’ accompanied by the relevant qualification shall be indicated e.g. ‘European Union certificate of qualification in inland navigation – Able boatman (3)’.
As regards certificates of qualifications issued in accordance with the Regulations for Rhine Navigation Personnel, the title ‘CCNR certificate of qualification’ accompanied by the relevant qualification shall be indicated e.g. ‘CCNR certificate of qualification – Able boatman (3)’.
Service time U.K.
Holder assumed service as: the function shall be numbered according to instruction for keeping the logbook.
Physical characteristics of the certificate: Colour: white background. Format A5 according to ISO 216.