Medical certificate for service at sea appendix iv 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the examinee's Family Name and Given Names in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the Date of Birth using the format day/month/year, and select the appropriate Sex option (Male or Female).
4. Provide the Home Address, Passport No./Discharge Book No., and Nationality in their respective fields.
5. In the evaluation section, specify the basis of your evaluation according to national law or regulations.
6. Indicate whether the examinee is Fit or Not Fit for various duties (look-out duty, deck service, engine service, catering service) by checking the appropriate boxes.
7. Complete any additional tests performed (Chest X-ray, Bacteriological stool test, Parasitical stool test) and note their results.
8. Document any restrictions regarding specific positions or trade areas if applicable.
9. Finally, enter the Place of Examination and Date. Ensure that both you and the medical examiner sign where indicated.

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