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    Republic of The Philippines Department of Transportation and Communications STCW Office

    Uploaded by

    Heralynn Baloloy
    1) The document is a screening form for Vincent Rojales' application for issuance of a Certificate of Proficiency (CoP) from the Philippine Maritime Industry Authority (MARINA). 2) It lists the documentary requirements for his application and whether they were submitted or not, including training records, sea service certificates, medical certificates, and photographs. 3) The form also acknowledges receipt of his application, lists the fees owed, and provides spaces for payment details and signatures from evaluators and cashiers processing his application.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Republic of The Philippines Department of Transportation and Communications STCW Office

    Uploaded by

    Heralynn Baloloy
    16 views1 page
    1) The document is a screening form for Vincent Rojales' application for issuance of a Certificate of Proficiency (CoP) from the Philippine Maritime Industry Authority (MARINA). 2) It lists the documentary requirements for his application and whether they were submitted or not, including training records, sea service certificates, medical certificates, and photographs. 3) The form also acknowledges receipt of his application, lists the fees owed, and provides spaces for payment details and signatures from evaluators and cashiers processing his application.

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    Form

    Original Title

    Issuance SOP

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    1) The document is a screening form for Vincent Rojales' application for issuance of a Certificate of Proficiency (CoP) from the Philippine Maritime Industry Authority (MARINA). 2) It lists the documentary requirements for his application and whether they were submitted or not, including training records, sea service certificates, medical certificates, and photographs. 3) The form also acknowledges receipt of his application, lists the fees owed, and provides spaces for payment details and signatures from evaluators and cashiers processing his application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    16 views1 page

    Republic of The Philippines Department of Transportation and Communications STCW Office

    Uploaded by

    Heralynn Baloloy
    1) The document is a screening form for Vincent Rojales' application for issuance of a Certificate of Proficiency (CoP) from the Philippine Maritime Industry Authority (MARINA). 2) It lists the documentary requirements for his application and whether they were submitted or not, including training records, sea service certificates, medical certificates, and photographs. 3) The form also acknowledges receipt of his application, lists the fees owed, and provides spaces for payment details and signatures from evaluators and cashiers processing his application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    CERT No.

    :04-04
    Initial Issue Date: 09-19-2013 Appointment Date: Nov 13, 2015 Appointment Time: 12:00
    Revision Date: 09-09-2014
    Republic of the Philippines
    Department of Transportation and Communications
    MARITIME INDUSTRY AUTHORITY
    STCW OFFICE

    SCREENING FORM
    APPLICATION FOR ISSUANCE OF CERTIFICATE OF PROFICIENCY

    NAME OF SEAFARER ROJALES VINCENT SESIMA APPLICATION NO. 39-2014-71541


    CELLPHONE 09062221280 E-MAIL ADDRESS [email protected]
    ADDRESS 091HALAYHAY TANZA CAVITE 4108 COURSE TO APPLY:
    - SDSD

    SIGNATURE OVER PRINTED NAME OF SEAFARER / AUTHORIZED REPRESENTATIVE


    Documentary Requirement
    Submitted Not Submitted
    (Please bring the original for verification)
    A. Other COPs (Chapters V & VI)
    1. Certified true copy of fully accomplished Training Completion of Records of Assessment (TCROA)
    2. Certified true copy of Enrollment Report
    3. Certified true copy of Training Certificates issued
    4. Copy of filled-up SIRB pages (including 1st page) for courses requiring sea service
    5. Certificate of Sea Service from Manning/Shipping Co. (in MARINA prescribed form)
    6. Copy of Valid Medical Certificate issued by DOH Accredited Medical Clinic
    7. For Manning/MTIs: 2 copies ID Pictures taken within last 6 months, passport size, in white background in
    appropriate uniform in soft copy (USB or CD), as applicable
    B. For Watchkeeping NEW RENEWAL
    1. Photocopy of COP on Basic Safety
    2. Certificate of Sea Service from Manning/Shipping Co. (in MARINA prescribed form)
    3. Copy of filled-up SIRB pages for courses requiring sea service
    4. TESDA Certificate of Competency (COC) (for renewal only) / Registry of ratings assessed and certified (New
    Entrant)
    5. Copy of Valid Medical Certificate issued by DOH Accredited Medical Clinic
    6. For Manning/MTIs: 2 copies ID Pictures taken within last 6 months, passport size, in white background in
    appropriate uniform in soft copy (USB or CD), as applicable
    C. For Expedite processing, Certified True Copy of the following (in addition to the above requirements):
    1. Letter Request
    2. Valid Overseas and Employment Certificate (OEC)
    3. Employment Contract
    4. Air Ticket/Flight Details
    Screen and Evaluated by: _______________________ Date/Time:
    Signature over Printed Name
    (Document Evaluator) CASHIER'S USE ONLY
    O.R. No.: _______________________
    Action Taken/Remarks: ____________________________ Date: ___________ Amount _________

    ACKNOWLEDGEMENT

    Name of company/applicant: ROJALES VINCENT SESIMA Date filed: NOVEMBER 05, 2015

    This is to acknowledge receipt of your application for ISSUANCE OF CERTIFICATE OF PROFICIENCY with assigned APPLICATION NO. 39-2014-71541

    Rest assured that subject application shall be acted upon by the appropriate office/s of this Agency.

    Document Evaluator: __________________________ DATE/TIME OF RELEASE: ______________________________


    Signature over Printed Name

    AUTHORITY TO ACCEPT PAYMENT

    APPLICATION CONTROL NO. 39-2014- 71541


    NAME OF COMPANY/APPLICANT: ROJALES VINCENT SESIMA
    Item No. of Pcs Amount
    Issuance / Renewal of CoP/s
    Expedite CoPs
    Certified True Copy
    TOTAL P
    Document Evaluator ____________________________ Date/Time: ______________________
    Signature over Printed Name
    CASHIER'S USE ONLY:
    O.R. No.:
    Date/Time

    _______ Cash Payment received by:


    Mode of Payment: _______ Check No.________ (Cashier's Printed Name &
    Date Issued __________ Signature)

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