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REPUBLIC SERBIE
Oz.na 1 broJ serije ... ...N... ........Q Q 13Q 1
Mark and Se
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No. register
POMORSKL KNJIZICA
SEAMAN'S BOOK
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Prezimc - Surnamet
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lme - First Name
.......S.N....E.D.f..gfJ!...:S. .... t 0..,. ....:. :4CJ{£.
·Mesto iJalum rodcnja - Place and D,ne of Birth
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Optini:I- Commune
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Republika -Republic ,
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LlC N I OP l S _ PER SO N AL O f SCR lPTl ON
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StgnatUTe ot holder o( sman's Book.)
TOhvias kbnojoi}k.lchaasizbdeaelanjies.osuded ..by.....k..........f
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Mark and Stria l Numbtr
PO'IVRDA O LEKARSR.0"'1 PREGLEDU
MEDICAL EXAM INATION CER1U'lCATE
Premc1 lekar:;kom uverenju izdatom od .../:!..r.J?....:..... .&......
Byvirtue oi Medical Ccnlficote issued by
f!.:...fJf.?..q"!X:l pod br.3..li$3... Jana ?::f.1.1 .m No. on
vlasnik ove knjiticc sFsoban je za sltdbu na brod u, i to:
the bolda o( Lhi:.- honk is fit for sorvice on txmrd ship1 i. e.:
na palulii - u stroju - u $}u:lbi vcze - u optoJ slulbi.
in 1he deck departm ent - In the engine room departmeol
- in the radio department - in (he catering depart ment.
Mlirk :1.nu SerialNumher
1'01'RDA O LEKARSK OM PREGLEDIJ
M El)I CAI.EXAMI N ATI ON CF.RTJli'T C,l'E
Prema lck:u-.;kom uveronju i:1datom od ......... ....................................
By virt ue or Medi<:Rl Cenilicatc is-..:ucd by
u ............... ................ pod br ......···-•····-..... dana .............
in No. nn
vlasnik ave knji:licc sposoban Je ?.'a l>lufuu na bmdu, i to:
the holder of this book is ul for service cm bo::iru i.h1p. l e
na paJubi - u troJU - u. :,lufh.i V<:1':e - u opstoJ slu7.lii.
m lh<.: deck lkparur..cut - mlhc engine room dcpanment
- In 1hc rad io dc.:parlmcn1 - in Lhc catering departmen t.
!J ......................... .................. dana .............. .. .. ..-....19 ............
U . .{.!Y:J).f lr-d na 14. {/.:.....?..fn OR ;::
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€).:... ln on
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(Potptso,laUcnog lien -
Signa ture ot authorized person)
, 1 IS
Sign ' thorfzed person)
KRY.NA GRUPA - BLOOD GROUP
Krvna grupa ..............................
Blood group
R.h ..._..................................... .
Rh
(M.P.)
(l•.S.)
U .......................................... dana .................................
In on
· .. ....1.. . .. ..
(Potpis ldrnra -
Dok1or's Signature)
POTV R DA O 1.E.KARS.K OM Plt EG LED U
MEUICAL EXAMlN A
.TIOl CERTU"J CATE
PremH 1t karsko1n uvcrcnju i1.1la1om od ..... ...........................................
By,·11wc of Mcdirn l Certificate issued by
u ............... .................po<.! t.,r .. .....-........ . dana ...... ......
in No. on
vlasnik 11v knJitice posoban Je z -.lufuu na brrn.lu. i to;
lhe holdc cf this b<,okis fit fur rvicc on hnard ship; i. e.:
n::i palub1 - u stroJ u - u 1utb1 vc7c - u ocnj slulb1
an .the UC(.:k cpai tmcnt - in tl_1e engine room depart ment
- t.n the radio dpartmi::nt - m lht: cat ring depat t mc.:nt.
U .............................. ........ ... dana .. .... ..................
In >- on
(Po1p1s ovl11stcnoi Ilea -
Signature uf aucJmnzcd person)
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M:irk and S1:rial Number
Marl:: nndS«ial Number
UKRCAN-SIGNEDON
R ANIJA llKRCAV ANJ A
PU.EVIOUS SEA SERVICE
Ukupno vrcme Lrajanja plovklbe na hrouuvima koji plove
U luci .......-------···..····-·---- ·d:1na ,_..,, ............ ..............................
In Lile portof on
U,JVOJSlVU ......... ......_...........-...... ........................ .................. .............,---------·- ·-- ...-
'a the capacity of .
Na brodu··-·-........-............'"'""""----·· Lubl up1$'l ..................................- --..--...
On board1hc Port o(rcg,stratloo
lJRT1. . . . . . . . . . . .,. .- ,,, -• n- 1,1,,•·•...,.,,,,11,11 1H H M Ut t••• ••• •'KS' .,.,.,..,,,,,,,,,,,,,,,,,,,,,,,,1,,111, 1,, 1 1 0 111111,,n_...,.'l''"""'"'rr l' ' ..
u granicama: - Total time spent in se1vicc on board:
GRT lliP
o t i···················"·"""""-··----- ·· rJnn ........-.........................................-....
doge ploviut e ...:-C.: godina _.:::::::: mcseci .C.. dana
Vl"llkc obalne .,,,,,..,-- ,,--
plovidbe ..•••••..•• mCCI ............. dana
vessels pyinin months days
Mediterranean trade ..male obalne
r . !t;;..................... ·-..-·..·:::.···......... ......_........_....................................................
, ..
• ,,,. - • ., .• . . ......( Polpr.1°1::apcllma brod a- ........
.l Sign1'ture of Ship'sM$Ler)
Slue! ..a podacima oz poptSfl pQS&d.:i:c.da1im 9cJ ........... .-....................................................
ndon1.kal"l.ilh cbe d111.1in rew L:iw by,-........... chnn ................... .......... ..._
io I No. on
plovidbe ........... god ma ......... meseci /' dana u1•••••••••••••• •000 0•• •-· -•_..-:- --y••·•- ••t ""• ; _. 1 ,, , ,,-. _. dnna -,11-IH,oj,u Ull ,ll,UIIIIII I .URf f -'ll " I M I Htl t •
vessels plying in years months days
Adriatic and Jonian trade
plovidbejugoslovcnsidm....---
obalnim morem gOdina mcseci dana
vesselsplying in the ycal'.!> months days
Yugoslav ooaslalsea
.,,...--- ,,----
lokalnc plovidbc godina rneseci dana
vessels engaged years mont hs days
In , • 6n ,
(il ,·.1!11 l:., i.11,;i :;lm"1;·;,;,j,;,;;,;,;k·,; ii,.'..
k ,11.ml;ini,J precJ,1 v111(r,·,1'irhue
I mi ,, ,nrm tw l brhour rJt11cc ·or dtplmn.11ic c1 .::onsul ir
1 1,,,,,ttl,1111111111 "nb111
l'i'K J<CAN -SICN l,,:.U O FF
Ulu ,.,...-............- ...._.......................-. darn, ......... .......................................'""'
In lhe Po" of on
Slu-lba iin,,, ·--·-..·-----..-·&ldin; .............................mc:scc:i ......_....................:c•f y 'llr, montbs d:yi s
in Joc-c1l trade
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Employed
(Potpis krpcisoabodfl-
S1gnn1 urc o(Sbip',l.1Ester)
In on
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In on
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(}lotpi.s 0 (moglie.a -
Signature',6£..-iuiliorii.ed person)
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lwn111l,r11,11• 1•11 1b1..11il'Js11111<
E11<lu(111, 111 i.:,- 1lm1.,.,ur t)llln' 11tl11,l1111,,1l.1. •1,.111,111,ll
.. r· ),j>MlUllllJI ulS1l•111
foreign gomgvessels years months day&