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II SÉRIE-A — NÚMERO 83 34

The lawful holder of this endorsement may serve in the following capacity or capacities specified in the safe

manning requirements of the Administration:

Capacity Limitations applying (if any)

Endorsement No. ………………….. issued on ……………….

(Official Seal )

...........................................................

Signature of duly authorized official

...........................................................

Name of duly authorized official

Date of birth of the holder of the certificate ……………

Signature of the holder of the certificate …….................

Photograph of the holder of the certificate

The validity of this endorsement is hereby extended until ……………………………………..

(Official seal) …………………….………………………………….

Signature of duly authorized official

Date of revalidation ……………………. ………………………………….……………………

Name of duly authorized official

The validity of this endorsement is hereby extended until ……..…………………..……………..

(Official seal) ………………………………….…………………….

Signature of duly authorized official

Date of revalidation ……………………. ………………………….……………………………

Name of duly authorized official