PANAMA格式海员健康证明书.docx

文档介绍：MODELOFMARITIMEDECLARATIONOFHEALTH (Nationality)(Flagofvessel)________________________________Master’sname_______________________________Grosstonnage(ship)_________________ValidSanitationControlExemption/ControlCertificatecarriedonboard?Yes_______No________Issuedat__________date__________Re-inspectionrequired?Yes__________No_________Hasship/anization?mencementofvoyagewithdateofdeparture,orwithinpastthirtydays,whicheverisshorter:petentauthorityattheportofarrival,listcrewmembers,passengerorotherpersonwhohavejoinedship/vesselsinceinternationalvoyagebeganorwithinpastthirtydays,whicheverisshorter,isincludingallportscountriesvisitedinthisperiod(addadditionalnamestotheattachedschedule).Name______________Joinedfrom:(1)_______________(2)________________(3)______________Name______________Joinedfrom:(1)_______________(2)________________(3)______________Name______________Joinedfrom:(1)_______________(2)________________(3)ident?Yes_______No________Ifyes,?Yes_____N