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 <DIV id="">
<DIV id="p2dimg1">
<P class="p56 ft62">Annexure - IV</P>
<P class="p57 ft63">Medical Certificate for Service at Sea</P>
<P class="p58 ft63">[Issued Under the Authority of Directorate General of Shipping, Govt. of India Under Rule No.4 of M.S</P>
<P class="p59 ft63">(Medical Examination) Rules, 2000 as amended]</P>
<P class="p60 ft63"><?=$customer['customer_name']?></P>
<TABLE cellpadding=0 cellspacing=0 class="t2">
<TR>
  <TD class="tr6 td235"><P class="p13 ft64"><NOBR><?php echo date("d-m-Y", strtotime($customer['dob']));?></NOBR></P></TD>
  <TD class="tr6 td132"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td16"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td236"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td2"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td58"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td237"><P class="p61 ft64">MALE</P></TD>
  <TD class="tr6 td238"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td239"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr15 td240"><P class="p7 ft19">&nbsp;</P></TD>
  <TD colspan=3 class="tr15 td241"><P class="p7 ft19">&nbsp;</P></TD>
  <TD class="tr13 td2"><P class="p7 ft24">&nbsp;</P></TD>
  <TD class="tr15 td242"><P class="p7 ft19">&nbsp;</P></TD>
  <TD class="tr15 td243"><P class="p7 ft19">&nbsp;</P></TD>
  <TD class="tr13 td238"><P class="p7 ft24">&nbsp;</P></TD>
  <TD class="tr13 td239"><P class="p7 ft24">&nbsp;</P></TD>
</TR>
<TR>
  <TD colspan=4 class="tr9 td244"><P class="p13 ft65">Date of Birth :( dd/mm/yyyy)</P></TD>
  <TD class="tr9 td2"><P class="p7 ft66">&nbsp;</P></TD>
  <TD colspan=2 class="tr9 td245"><P class="p34 ft67">Gender :( Male/Female)</P></TD>
  <TD class="tr9 td238"><P class="p7 ft66">&nbsp;</P></TD>
  <TD class="tr9 td239"><P class="p7 ft66">&nbsp;</P></TD>
</TR>
<TR>
  <TD colspan=2 class="tr21 td236"><P class="p13 ft67">Indian Passport / CDC No</P></TD>
  <TD colspan=2 class="tr22 td246"><P class="p31 ft64"><?=$customer['passport_no']?></P></TD>
  <TD colspan=2 class="tr21 td247"><P class="p13 ft64">Valid until</P></TD>
   <TD colspan=2 class="tr22 td246"><P class="p31 ft64"><?php echo date("d-m-Y", strtotime($customer['passport_validity']));?></P></TD>
  <TD class="tr22 td248"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr21 td239"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr21 td235"><P class="p13 ft67">Has been examined by</P></TD>
  <TD class="tr22 td249"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td250"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td251"><P class="p49 ft68">Dr. Ushas Kumar G</P></TD>
  <TD colspan=3 class="tr22 td252"><P class="p16 ft68">KRL/ERN/032017</P></TD>
  <TD class="tr22 td248"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td253"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
</TABLE>
<P class="p62 ft64">(Name of the Medical Examiner and Approval No.)</P>
<P class="p63 ft64">And has been found FIT for sea service at sea in the job of.</P>
<P class="p63 ft69">If Unfit / Temp Unfit, Specify Reason-</P>
<hr>
<hr>
<P class="p64 ft64"><SPAN class="ft64">(a)</SPAN><SPAN class="ft70">The hearing and sight of the seafarer concerned, and the colour vision in the case of a seafarer to be employed in capacities where fitness for the work to be performed is liable to be affected by defective colour vision, are all satisfactory; and</SPAN></P>
<P class="p65 ft64"><SPAN class="ft64">(b)</SPAN><SPAN class="ft71">The seafarer concerned is not suffering from any medical condition likely to be aggravated by service at sea or to render the seafarer unfit for such service or to endanger the health of other persons on board.</SPAN></P>
<P class="p66 ft67"><SPAN class="ft67">(c)</SPAN><SPAN class="ft72">The Seafarer complies with the requirements specified in Table </SPAN><NOBR>A-I/9</NOBR> of STCW Code (i.e. Minimum in service eyesight standards for seafarers), Table <NOBR>B-I/9</NOBR> of the STCW Code (i.e. Assessment of minimum entry level and <NOBR>in-service</NOBR> physical abilities for seafarers) and Regulation 1.2, Standard <NOBR>A-1.2</NOBR> & Guideline <NOBR>B-1.2</NOBR> of the Maritime Labour Convention 2006.</P>
<TABLE cellpadding=0 cellspacing=0 class="t3">
<TR>
  <TD colspan=2 class="tr6 td254"><P class="p67 ft64"><?php echo date("d-m-Y", strtotime($customer['added_date']));?></P></TD>
  <TD colspan=4 class="tr6 td236"><P class="p8 ft64">KOCHI</P></TD>
  <TD class="tr6 td255"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td256"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr20 td257"><P class="p7 ft58">&nbsp;</P></TD>
  <TD colspan=2 class="tr20 td258"><P class="p7 ft58">&nbsp;</P></TD>
  <TD class="tr20 td259"><P class="p7 ft58">&nbsp;</P></TD>
  <TD class="tr23 td40"><P class="p7 ft73">&nbsp;</P></TD>
  <TD class="tr23 td260"><P class="p7 ft73">&nbsp;</P></TD>
  <TD class="tr23 td255"><P class="p7 ft73">&nbsp;</P></TD>
  <TD class="tr23 td256"><P class="p7 ft73">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr14 td40"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td261"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td41"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td11"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td40"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td260"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr14 td255"><P class="p7 ft18">&nbsp;</P></TD>
  <TD class="tr8 td262"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD colspan=6 class="tr6 td263"><P class="p24 ft64">(Date & Place of Medical Examination)</P></TD>
  <TD class="tr6 td255"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td256"><P class="p21 ft64">(Signature of the Medical Examiner)</P></TD>
</TR>
<TR>
  <TD colspan=2 class="tr22 td254"><P class="p68 ft64"><?=$customer['lead_id']?></P></TD>
  <TD class="tr22 td41"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td11"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td255"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td256"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr15 td40"><P class="p7 ft19">&nbsp;</P></TD>
  <TD colspan=2 class="tr16 td258"><P class="p7 ft27">&nbsp;</P></TD>
  <TD class="tr16 td259"><P class="p7 ft27">&nbsp;</P></TD>
  <TD class="tr16 td257"><P class="p7 ft27">&nbsp;</P></TD>
  <TD class="tr15 td260"><P class="p7 ft19">&nbsp;</P></TD>
  <TD class="tr15 td255"><P class="p7 ft19">&nbsp;</P></TD>
  <TD class="tr15 td256"><P class="p7 ft19">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr6 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD colspan=5 class="tr6 td264"><P class="p22 ft64">(Serial number of the Certificate)</P></TD>
  <TD class="tr6 td255"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr6 td256"><P class="p7 ft6">&nbsp;</P></TD>
</TR>
<TR>
  <TD class="tr22 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td261"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td41"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td11"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td11"><P class="p7 ft6">&nbsp;</P></TD>
  <TD colspan=2 class="tr22 td265"><P class="p52 ft68">Address:</P></TD>
</TR>
<TR>
  <TD colspan=6 class="tr21 td263"><P class="p24 ft64"><NOBR><SPAN class="ft68">E-mail</SPAN></NOBR><SPAN class="ft68"> ID: </SPAN>ushaskumar7@gmail.com</P></TD>
   <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
  <TD colspan=2 class="tr21 td265"><P class="p52 ft64">Door No. 39/1492, 1st Floor, Kalathiparampil Cross Road,</P></TD>
</TR>
<TR>
  <TD class="tr22 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td261"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td41"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td11"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td40"><P class="p7 ft6">&nbsp;</P></TD>
  <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
   <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
  <TD colspan=2 class="tr22 td265"><P class="p52 ft64">Ernakulam South, Cochin - 682016.</P></TD>
</TR>
<TR>
  <TD colspan=6 class="tr21 td263"><P class="p24 ft64"><SPAN class="ft68">Contact No: </SPAN>+91 9895209326</P></TD>
   <TD class="tr22 td260"><P class="p7 ft6">&nbsp;</P></TD>
  <TD colspan=2 class="tr21 td265"><P class="p52 ft64">Phone: <NOBR>0484-2375557,</NOBR> 9895209326</P></TD>
</TR>
<?php
$date = strtotime($customer['added_date']);
       $newdate = date('d-m-Y',strtotime("+2 year",$date));
          $expire = date('d-m-Y',strtotime($newdate . ' -1 day'));
?>
       
?>
<TR>
  <TD colspan=6 class="tr24 td263"><P class="p45 ft64">This Certificate expires on* <?=$expire?></P></TD>
  <TD colspan=2 class="tr24 td265"><P class="p21 ft64">Official Stamp of the Medical Examiner</P></TD>
</TR>
<TR>
  <TD class="tr3 td40"><P class="p7 ft9">&nbsp;</P></TD>
  <TD class="tr3 td261"><P class="p7 ft9">&nbsp;</P></TD>
  <TD class="tr3 td41"><P class="p7 ft9">&nbsp;</P></TD>
  <TD class="tr4 td259"><P class="p7 ft10">&nbsp;</P></TD>
  <TD class="tr4 td257"><P class="p7 ft10">&nbsp;</P></TD>
  <TD class="tr4 td266"><P class="p7 ft10">&nbsp;</P></TD>
  <TD class="tr3 td255"><P class="p7 ft9">&nbsp;</P></TD>
  <TD class="tr3 td256"><P class="p7 ft9">&nbsp;</P></TD>
</TR>
</TABLE>
<P class="p69 ft64">(Day, Month, Year)*</P>
<P class="p70 ft69">(* Not more than 2 years from the date of issue, unless the seafarers is under the age of 18, in which case the maximum period of validity of the Medical Certificate shall be 1 year).</P>
<P class="p71 ft69">If the period of validity of the medical certificate expires in the course of voyage, the medical certificate shall continue in force until the next port of call where an approved Medical Examiner is available and the seafarer can obtain a medical certificate, provided that period of such extension shall not exceed 3 months.</P>
</DIV>

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