A request - Blue Nose Certificate

All Seamen, Wherever Ye May Be, Greetings: Know All Be by these Presents that ___________ did on _________ appear in the Northernmost Reaches of my realm embarked in HMS_________ in latitude 66º 33’ N and in longitude _____ bound for Dark and Frosty Wastes of The Land of the Midnight Sun and did with My Royal Permission enter this Dread Region by crossing The Arctic Circle by virtue whereof. I Neptunus Rex Ruler of the Raging Main do hereby declare him to be a loyal and trusty Bluenose and do call upon all Icebergs, Polar Bears, Whales, Norwhals, Sealions and other Creatures of the Frigid North, to show him due deference and respect. Disobey under pain of My Royal Displeasure.
Neptunus Rex
Ruler of the Raging Main

Queen of his Majesty’s Northern

There are several variations, try Google and see if you recognise it.

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