# Commission Implementing Regulation (EU) 2020/182 of 14 January 2020 on models in the field of professional qualifications in inland navigation (Text with EEA relevance), Annex III: MODEL FOR PRACTICAL EXAMINATION CERTIFICATES

Extent: E+W+S+N.I.

We, name of the examining body,
hereby certify with document number …that
1.. Current family name(s) of the holder
2.. Current first name(s) of the holder
3a. Date of birth (dd/mm/yyyy)
3b. Place of birth (city)
has passed the practical examination [for obtaining a certificate of qualification as a boatmaster] [and] [for a specific authorisation for sailing with the aid of radar]
on the simulator (name of the simulator), approved by (name of the competent authority).
Place and date of issue
Signature and stamp of the examining body

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Source: https://www.legislation.gov.uk/eur/2020/182/annex/III (the official version)
Page: https://openlegislation.uk/eu-regulation-2020-182/annex-III
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.