ANNEX II

MODEL FOR THE SINGLE DOCUMENT COMBINING UNION CERTIFICATES OF QUALIFICATION AND THE SERVICE RECORD BOOK

Page 1 of the model

Name of country

Service record book combined with certificates of qualification

Identification of the holder 2D barcode 1. Name(s) of the holder: 2. First name(s): 3a. Date of birth: 3b. Place of birth: 4. Crew member identification number: 5. Photo

Identification of the service record book

1. Serial number:

2. Date of issue:

3. Issuing authority:

4. Signature and stamp of issuing authority:

5. Serial number of former service record book:

SRBXXXXSSSS

Page 2 of the model

European Union certificates of qualification and certificates of qualification issued according to the Regulations for Rhine Navigation Personnel as apprentice, deckhand, boatman, able boatman and helmsman

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

SRBXXXXSSSS

Page 3 of the model

Other certificates concerning qualifications relevant for inland navigation

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

Title of certificate: ________________________________________

Fitness related mitigation measures and restrictions:

Serial number:

Date of issue: Date of expiry:

Issuing authority:

Signature and stamp of issuing authority:

SRBXXXXSSSS

Page 4 of the model

Service time

Service time on board, name of craft:

Unique European vessel identification number or other official craft number:

Type of craft (1):

State of registration:

Length of craft in m (*1)/number of passengers (*1):

Owner (name and address):

Holder assumed service as (2):

Holder assumed service on (date):

End of service (date):

Boatmaster (name and address):

Place, date and signature of boatmaster:

Service time on board, name of craft:

Unique European vessel identification number or other official craft number:

Type of craft

State of registration:

Length of craft in m (*1)/number of passengers (*1)

Owner (name and address):

Holder assumed service as:

Holder assumed service on (date):

End of service (date):

Boatmaster (name and address):

Place, date and signature of boatmaster:

SRBXXXXSSSS

Pages 5 to 22 as page 4

Page 23 of the model

Navigation time and stretches of inland waterways sailed over last 15 months Year:…

The number of days navigated must be consistent with the navigation time entered in the logbook!

Name of craft or unique European identification number or other official craft number journey from via to (km) Start of journey (date) Days of interruption End of the journey (date) Total number of navigation days Signature of boatmaster A B C D E F G 1 2 3 4 5 6 7 8 9 10

Complete document ☐ yes ☐ no

☐ Doubts at line(s):________

Doubts have been eliminated by presenting ☐ (parts of) the logbook ☐ other official documents

Space reserved for the competent authority

To be completed by the authority: total number of navigation days taken into consideration from this page

Validation mark of the competent authority

Presented on (date) ___________

Signature and stamp of the authority

SRBXXXXSSSS

Pages 24 to 55 as page 23

Headings of columns A to G not printed on those pages

Page 56 of the model

Without content

Instructions for the issuing authorities

Identification of the holder

1. Current family name(s) of the holder

2. Current first name(s) of the holder Names shall be those appearing on the ID card or passport of the person concerned and shall be entered in UNICODE. If a name is spelled differently in UNICODE and in ASCII, there shall also be transcribed in ASCII in brackets.

3a. Date of birth (dd/mm/yyyy)

3b. Place of birth (city)

4. Crew member identification number of the holder (CID) as attributed in the database referred to in Art. 25(2) of Directive (EU) 2017/2397 of the European Parliament and of the Council.

Identification of the service record book

The serial number of the service record book shall consist of:

— the crew member’s CID;

— the type of document as coded in the European Reference Data Management System (ERDMS); the issuing authority as coded in ERDMS;

— the number of the document in 4 digits.

The serial number of the service record book without the part on CID shall be repeated in the lower section of each page.

Certificates of qualification

The title of the issued certificate shall be inserted (in caps font) by the relevant competent authority. It shall be complemented by the following numbers in brackets, as appropriate: ‘(2)’ for Helmsman, ‘(3)’ for Able boatman, ‘(4)’ for Boatman, ‘(5)’ for Deckhand and ‘(6)’ for Apprentice.

As regards the Union certificates of qualifications, the title ‘European Union certificate of qualification in inland navigation’ accompanied by the relevant qualification shall be indicated for example ‘European Union certificate of qualification in inland navigation – Able boatman (3)’.

As regards certificates of qualifications issued in accordance with the Regulations for Rhine Navigation Personnel, the title ‘CCNR certificate of qualification’ accompanied by the relevant qualification shall be indicated for example ‘CCNR certificate of qualification – Able boatman (3)’.

Physical characteristics of the document

Colour: cover: light blue Pantone 290C; white background of inner pages

Format A5 according to ISO 216

Example of a filled in entry for service time

Service time on board, name of craft: UNTERWALDEN

Unique European vessel identification number or other official craft number: 07000281

Type of craft1:

State of registration: CH

Length of craft in m*/number of passengers* 105 m

Owner (name and address):

TSAG, Hauptstrasse 55, CH-4127 Riehen, Basel-Stadt

Holder assumed service as2: 3

Holder assumed service on (date): 22.10.1995

End of service (date): 22.11.1996

Boatmaster (name and address):

K. Huber, Rheinstrasse 55, D-76497 Wintersdorf

Place, date and signature of boatmaster: Rotterdam, 20.11.1996

K.Huber

Example of a filled in page for navigation time and stretches sailed

Navigation time and stretches of inland waterways sailed over last 15 months Year: 2015/2016

The number of days navigated must be consistent with the navigation time entered in the logbook

A B C D E F G 1 07000281 Rotterdam (999,90)Mainz (500,00) Wien (1930,00) 22.11.15 11 17.12.15 15 Signature Huber 2 07000281 Wien (1930,00) Mainz (500,00) Basel (169,90) 20.12.15 4 4.1.16 12 Signature Huber 3 07000281 Basel (169,90) Rotterdam (999,90) 6.1.16 0 10.1.16 5 Signature Huber 4 07000281 Rotterdam (999,90) Antwerpen (20,00) Basel (169,90) 13.1.16 1 23.1.16 10 Signature Huber 5 07000281 Basel (169,90) Antwerpen (20,00) 25.1.16 0 29.1.16 5 Signature Huber 6 07000281 Antwerpen (20,00) Basel (169,90) 1.2.16 0 7.2.16 7 Signature Huber 7 07000281 Base (169,90) Mainz (500,00) Bratislava (1867,00) 9.2.16 5 22.2.16 9 Signature Huber 8 07000281 Bratislava (18657,00) Regensburg (2376,30) 27.2.16 0 2.3.16 5 Signature Huber 9 07000281 Regensburg (2376,30) Mainz (500,00) Rotterdam (999,90) 3.3.16 0 9.3.16 7 Signature Huber 10 07000281 Rotterdam (999,90) Basel (169,90) 12.3.16 0 17.3.16 6 Signature Huber

Complete document ☑yes ☐ no

☐ Doubts at line(s)__________

Doubts have been eliminated by presenting ☐ (parts of) the logbook ☐ other official documents

Space reserved for the competent authority

To be completed by the authority: total number of navigation days taken into consideration from this page 81

Validation mark of the competent authority

Presented on (date) 15.04.16

Signature and stamp of the authority

SRBXXXXSSSS

(1) For type of craft, always indicate if type C or G tanker, large convoy or if craft using LNG as fuel

(*1) Delete if not applicable

(2) Holder assumed service as’: the function must be numbered according to instruction for keeping the logbook