(Company name)

IMO CREW LIST

(IMO FAL Form 5)

Page Number

Arrival Departure
1.1 Name of ship 1.2 IMO number

1.3 Call sign 1.4 Voyage number

2. Port of arrival/departure 3. Date of arrival/departure

4. Flag state of ship 5. Last port of call

6 No. 7. Family name, given names 8. Rank or rating 9. Nationality 10. Date and 11. Nature and
place of birth number of identity
document

12. Date and signature by master, authorized agent or officer

 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that ANTON JANZ A. MILLANO holder of SIRB No. C0703578 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 08- 2017/01/26 2018/01/29 DECK 1-0-2
CALIXTA VI Cargo Ship 0000101 CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this _ _ _ day of _ _ __ at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that ____________________ had actually served

under our Supervision onboard __________________________________, _____________________
(Name of Vessel) (Type of Vessel)
of _______________________ with Registry No. ___________, _________________________ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of __________________ KW and __________________ Gross Tonnage for a period of ____________

from ________________________ ______ to_____________________________________________

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as ______________________________.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this day of at ____.

SEAL OF VESSEL

______________________________
Master – Signature above Printed Name
Nationality : ___________________
Kind of License : ___________________
Registration No. : ___________________
Date of Registration : ___________________
Expiry Date : ___________________

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that ____________________ had actually served

under our Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO __ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______2 __ from __ 01/26/2017 ____ to 01/29/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as DECK CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this day of at ____.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that BABYMEL D. BAYBAYON holder of SIRB No. C0745518 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 Legazpi 2017/05/20 2018/05/23 DECK 1-0-3
CALIXTA VI Cargo Ship City, Albay CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this 30th day of May at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that DICK ELIVIR M. ESCOTO holder of SIRB No. C0745361 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 Legazpi 2017/05/18 2018/05/21 ENGINE 1-0-3
CALIXTA VI Cargo Ship City, Albay CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this 28th day of May at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that RYAN B. BARBECHO holder of SIRB No. C0765319 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 Legazpi 2017/05/20 2018/05/23 DECK 1-0-3
CALIXTA VI Cargo Ship City, Albay CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this 30th day of May at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that BABYMEL D. BAYBAYON had actually served

under our Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO __ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______3 __ from __ 05/20/2017 ____ to 05/23/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as DECK CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this 30th day of May at San Andres, Catanduanes.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that RYAN B. BARBECHO had actually served under our
Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO __ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______3 __ from __ 05/20/2017 ____ to 05/23/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as DECK CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this 30th day of May at San Andres, Catanduanes.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that DICK ELIVIR M. ESCOTO had actually served under our
Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO __ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______3 __ from __ 05/18/2017 ____ to 05/21/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as ENGINE CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this 28th day of May at San Andres, Catanduanes.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that CHRISTIAN D. LLOVIDO had actually served under our
Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO _ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______3 __ from __ 05/03/2017 ____ to 05/06/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as ENGINE CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this 8th day of May at San Andres, Catanduanes.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that CHRISTIAN D. LLOVIDO holder of SIRB No. C1020139 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 Legazpi 2017/05/03 2018/05/06 ENGINE 1-0-3
CALIXTA VI Cargo Ship City, Albay CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this 8th day of May at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex D

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

This certifies that ROMMEL N. MORATALLA had actually served under our
Supervision onboard _ _MV REGINA CALIXTA VI _, ___ PASSENGER / CARGO _ ___
(Name of Vessel) (Type of Vessel)
of PHILIPPINES________ with Registry No. 08-0000101 , _ DOMESTIC ____ vessel
(Vessel Nationality) (Near Coastal/Sea-going)
of _ 1,402.48 _ KW and _ 898.26 _ Gross Tonnage for a period of

1 0______7 __ from __ 05/15/2017 ____ to 05/22/2018_ ____

(No. of Years) (Months) (Days) (Date of Embarkation) (Date of Discharge)
as DECK CADET__ ____.
(Position Held)

This Further Certifies that the above-stated data are true that any false statement/s made herein shall
be ground for criminal prosecution.

Issued this 7th day of July at San Andres, Catanduanes.

SEAL OF VESSEL

CAPT. GENE B. POSADAS JR. _

Master – Signature above Printed Name
Nationality : FILIPINO_ _ __ _
Kind of License : MAJOR PATRON MARINA _
Registration No. : M1-0001863 __ _
Date of Registration : 05/25/1981_ ___ _ _
Expiry Date : NONE ____ __ _

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.
 Annex E

Republic of the Philippines

Office of the President
COMMISSION ON HIGHER EDUCATION

Department of Transportation and Communications

MARITIME INDUSTRY AUTHORITY

CERTIFICATE OF SEA SERVICE

Sir / Madam:

This is to certify that ROMMEL N. MORATALLA holder of SIRB No. C1019972 has been
an apprentice by this company with the following sea going service/s:

Period Covered Total

Name of Type Route Gross KW Registry From To Position Sea
Vessel (Foreign / Tonnage Power Y/M/D Y/M/D / Rank service
Domestic) Y-M-D
MV Ro - Ro
REGINA Passenger / Domestic 898.26 1,402.48 Legazpi 2017/05/15 2018/05/22 DECK 1-0-7
CALIXTA VI Cargo Ship City, Albay CADET

This further certifies that the above-stated data are true and that any false statement/s made herein
shall be ground for criminal prosecution.

Issued this 7th day of July at San Andres, Catanduanes.

MR. JERIC O. CUA / MS. KRISTINE THEA E. CUA/ MS. AIRA PATRICIA E. CUA COMPANY SEAL
President / Duly Authorized Person
Signature above Printed Name

SUBSCRIBED AND SWORN to before me this day of , 20 ,

At_________________________________

Doc No. :
Page No. :
Book No. :
Series of : Notary Public

Note:

This form is good only for one (1) vessel. This form can be reproduced. Any erasure / obliteration may be a ground for denial.