Australian Government - Australian Maritime Safety Authority
CERTIFICATE OF COMPETENCY APPLICATION – AMSA 426
Marine Safety (Domestic Commercial Vessel) National Law Act 2012
Marine Order 505 (Certificates of competency – national law) 2013
 

Guidance on how to use this form

You must respond to all questions and statements on this form and insert information in all boxes. If the information requested is unknown or not applicable insert N/A.

You can complete this form online or print and then complete by hand. You must click on Download pdf before printing. If you do not download a pdf version of the form there will be no barcode and Australia Post will not accept your application.

Please do not submit original documents with your application.


Proof of identity

Proof of identity is required when applying for a certificate of competency or seafarer’s service book.
Proof of identity is necessary to protect your identity, as well as our certification system.
Documents submitted as part of your proof of identity must be originals. You must present your documents to Australia Post at the time of lodging your application. Find a participating Australia Post outlet.

Five identity options
You must choose one of these five identity document options:

Option 1
Submit the following:
• Your current passport

Option 2
Submit the following:
• Your current Australian driver’s licence
• Your full Australian birth certificate or your Australian citizenship certificate

Option 3
Submit the following:
• A photographic identification document issued by an Australian Commonwealth, state or territory government agency
• Your current Australian Medicare card
• Your full Australian birth certificate or your Australian citizenship certificate

Option 4
Submit the following:
• Your current Australian Medicare card
• A current account card from a bank that shows your signature
• A proof-of-age card or student ID card that shows your photograph
• Your full Australian birth certificate or your Australian citizenship certificate

If the name on the identification documents (passport, driver’s licence, birth certificate, or citizenship certificate, etc) does not match the name on your application form, you must submit a copy of a change of name document to show your official name change.

Option 5 - Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander people born from 1969 onwards may be able to access their birth certificate through the births, deaths and marriages registry in the state or territory of their birth.
Aboriginal and Torres Strait Islander people born earlier than 1969 who do not have a birth certificate may be recorded in the Aboriginal Population Register available from the Northern Territory Registry of Births, Deaths and Marriages. We will accept this document as equivalent to a birth certificate.
If an Aboriginal or Torres Strait Islander person cannot provide proof of identity as required above, a completed Identity declaration for Aboriginal and Torres Strait Islander person form 162 will be accepted as being equivalent to option 1 (current passport).


 
CERTIFICATE OPTIONS
Certificate of competency type
Certificate of competency type
Certificate application type
Certificate application type

Medical declaration – New

Please answer 'Yes' or 'No' to the following questions and provide other information as requested:

  1. Do you have unclear speech or hesitation when you speak?
  2. Do you have trouble hearing a whispered voice or a watch ticking?
    Hearing aids are acceptable provided that their use does not impede watch keeping duties being adequately performed.
  3. Do you have a hernia that has not been corrected satisfactorily by a curative operation?
  4. Do you have any artificial limbs that are likely to prevent you from performing duties on a commercial vessel?
  5. Do you have a cardiac pacemaker implanted?
  6. Have you ever suffered from epileptic seizures?
  7. Do you have insulin dependent diabetes or any form of controlled diabetes?
  8. Have you been affected by pulmonary tuberculosis?
  9. Are you suffering from any medical condition or are you aware of a physical or mental incapacity that may affect your ability to perform duties under this certificate?



    Note:
    If you answered ‘Yes’ to any of the above questions, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
Medical declaration – Revalidation

Please answer 'Yes' or 'No' to the following questions and provide other information as requested:

  1. Do you have unclear speech or hesitation when you speak?
  2. Do you have trouble hearing a whispered voice or a watch ticking?
    Hearing aids are acceptable provided that their use does not impede watch keeping duties being adequately performed.
  3. Do you have a hernia that has not been corrected satisfactorily by a curative operation?
  4. Do you have any artificial limbs that are likely to prevent you from performing duties on a commercial vessel?
  5. Do you have a cardiac pacemaker implanted?
  6. Have you ever suffered from epileptic seizures?
  7. Do you have insulin dependent diabetes or any form of controlled diabetes?
  8. Have you been affected by pulmonary tuberculosis?
  9. Are you suffering from any medical condition or are you aware of a physical or mental incapacity that may affect your ability to perform duties under this certificate?



    Note:
    If you answered ‘Yes’ to any of the above questions, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
  10. Has there been any change to your eyesight including aids to vision or colour vision that would affect your ability to perform duties on a commercial vessel?



    Note:
    If you answered ‘Yes’ to the question above, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
Qualifying sea service declaration - Coxswain Grade 1 NC - New

Please select ‘Yes’ to either question 1 or question 2 and provide other information as requested:

  1. I have completed the AMSA approved Coxswain Grade 1 task book and at least 30 days sea service on commercial vessels ≥5 m long while working in a deck, or deck and engineering, capacity on board.
  2. I have completed at least 240 days sea service on vessels ≥5 m long while working in a deck, or deck and engineering, capacity on board.
  3. I have completed the Coxswain Grade 1 engineering units of the maritime training package.
  4. I have completed more than 50 percent of my sea service outside sheltered waters.
Note:
Sea service on a commercial vessel ≥4.5 m long while operating beyond sheltered waters within 5 nautical miles from the point of departure, shore base or aquaculture lease is considered equivalent for the above purposes.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If the Coxswain Grade 1 engineering units of the maritime training package are not completed, you will be issued with a Coxswain Grade 1 NC certificate restricted to inboard diesel engine with propulsion power <100 kW and unlimited outboard propulsion.
Note:
If more than 50 per cent of the required sea service is gained in sheltered waters, you will be issued with a Coxswain Grade 1 NC certificate restricted to sheltered waters or within 5 nautical miles from a departure point, shore base or aquaculture lease.
Qualifying sea service declaration - Coxswain Grade 2 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Coxswain Grade 2 task book and at least 7 days sea service on a vessel.
  2. I have completed at least 60 days sea service on a vessel.

Note: If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.


Optional endorsements

To have your certificate endorsed to carry passengers, please select ‘Yes’ to one of the following statements and provide a valid first aid certificate with your application

  1. I have completed the AMSA approved Coxswain Grade 2 task book and at least 30 days sea service on commercial vessels ≥5 m long while working in a deck, or a deck and engineering, capacity on board.
  2. I have completed at least 240 days sea service on vessels ≥5 m long while working in a deck, or a deck and engineering, capacity on board.

To have your certificate endorsed to command a vessel with inboard propulsion engine of up to 500kW, please select ‘Yes’ to the following statement and provide a copy of a certificate or document that shows the completion of the Coxswain Grade 1 NC engineering units of the MAR Maritime Training Package:

  1. I have completed the Coxswain Grade 1 engineering units of the maritime training package.
Qualifying sea service declaration - Marine Engine Driver Grade 1 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Marine Engine Driver Grade 1 task book and at least 240 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Coxswain Grade 1 NC, or Coxswain Grade 2 NC certificate endorsed for 500 kW inboard propulsion.
  2. I have completed at least 480 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Coxswain Grade1 NC, or Coxswain Grade 2 NC certificate endorsed for 500 kW inboard propulsion.
  3. I have completed the AMSA approved Marine Engine Driver Grade 1 task book and at least 180 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Marine Engine Driver Grade 3 NC certificate.
  4. I have completed at least 360 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Marine Engine Driver Grade 3 NC certificate.
  5. I have completed the AMSA approved Marine Engine Driver Grade 1 task book and at least 90 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a workshop skill equivalent qualification.
  6. I have completed at least 180 days sea service on a commercial vessel with inboard diesel engines with propulsion power ≥375 kW while holding a workshop skill equivalent qualification.
  7. I have completed the AMSA approved Marine Engine Driver Grade 1 task book and at least 120 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Marine Engine Driver Grade 2 NC certificate.
  8. I have completed at least 240 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥375 kW while holding a Marine Engine Driver Grade 2 NC certificate.
Note:
The qualifying sea service must be completed while performing duties as an engine driver, a chief engineer or second engineer; or as an assistant to an engine driver, a chief engineer or a second engineer; or as a general purpose hand.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If you hold a Coxswain Grade 1 NC, Coxswain Grade 2 NC endorsed for 500 kW inboard propulsion, or Marine Engine Driver Grade 2 or 3 NC certificate of competency, a copy of that qualification must be attached to this application.
Note:
If you have a workshop skill equivalent qualification, a copy of that qualification must be attached to this application.
Qualifying sea service declaration - Marine Engine Driver Grade 2 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Marine Engine Driver Grade 2 task book and have at least 180 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW.
  2. I have completed at least 360 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW.
  3. I have completed the AMSA approved Marine Engine Driver Grade 2 task book and at least 120 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW while holding a Coxswain Grade 1 NC, or Coxswain Grade 2 NC endorsed for 500 kW inboard propulsion, or a Marine Engine Driver Grade 3 NC, certificate.
  4. I have completed at least 240 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW while holding a Coxswain Grade 1 NC, or Coxswain Grade 2 NC endorsed for 500 kW inboard propulsion, or a Marine Engine Driver Grade 3 NC, certificate.
  5. I have completed the AMSA approved Marine Engine Driver Grade 2 task book and at least 90 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW while holding a workshop skill equivalent qualification.
  6. I have completed at least 180 days sea service on a commercial vessel with inboard diesel engines and propulsion power ≥150 kW while holding a workshop skill equivalent qualification.
Note:
The qualifying sea service must be completed while performing duties as an engine driver, a chief engineer or second engineer; or as an assistant to an engine driver, a chief engineer or a second engineer; or as a general purpose hand.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If you hold a Coxswain Grade 1 or 2 NC, or Marine Engine Driver Grade 3 NC, certificate of competency, a copy of that qualification must be attached to this application.
Note:
If you have a workshop skill equivalent qualification, a copy of that qualification must be attached to this application.
Qualifying sea service declaration - Marine Engine Driver Grade 3 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Marine Engine Driver Grade 3 task book and have at least 20 days sea service on a commercial vessel with propulsion power ≥75 kW.
  2. I have completed at least 60 days sea service on a vessel with propulsion power ≥75 kW.
  3. I have completed at least 50 per cent of the sea service in 1 or 2 above on a vessel with inboard diesel engines with propulsion power ≥75 kW.
Note:
The qualifying sea service must be completed as a general purpose hand or carrying out permitted duties of a Coxswain Grade 1 NC or Coxswain Grade 2 NC, or as assistant to an engine driver, to a chief engineer or to a second engineer.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If less than 50 per cent of your sea service is gained on vessels with inboard diesel engines and propulsion power ≥75 kW, you will be issued with a certificate restricted to vessels with outboard propulsion.
Qualifying sea service declaration - Engineer Class 3 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Engineer Class 3 task book and have at least 180 days sea service working on board as engineer in charge, or on duties assisting the engineer in charge, on a commercial vessel with inboard diesel engines and propulsion power ≥400 kW while holding a Marine Engine Driver Grade 1 certificate.
  2. I have completed at least 360 days sea service working on board as engineer in charge, or on duties assisting the engineer in charge, on a commercial vessel with inboard diesel engines and propulsion power ≥400 kW while holding a Marine Engine Driver Grade 1 certificate.
  3. I have completed the AMSA approved Engineer Class 3 task book and at least 120 days of sea service working on board on duties assisting the engineer in charge on a commercial vessel with inboard diesel engines and propulsion power ≥400 kW while holding a workshop skill equivalent qualification.
  4. I have completed at least 240 days sea service working on board on duties assisting the engineer in charge on a commercial vessel with inboard diesel engines and propulsion power ≥400 kW while holding a workshop skill equivalent qualification.
  5. I have completed at least 90 days sea service working on board performing engine-room watchkeeping duties on a commercial vessel with inboard diesel engines and propulsion power ≥400 kW while holding a certificate of competency as Engineer Watchkeeper issued under the Navigation Act 2012.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If you hold a Marine Engine Driver Grade 1 NC or Engineer Watchkeeper certificate of competency, a copy of that qualification must be attached to this application.
Note:
If you have a workshop skill equivalent qualification, a copy of that qualification must be attached to this application.
Qualifying sea service declaration - Master (Inland waters) - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Master (Inland waters) task book and at least 60 days sea service on board commercial vessels ≥7.5 m long while working in any deck capacity on board.
  2. I have completed at least 120 days sea service on vessels ≥7.5 m long while working in a deck, or deck and engineering, capacity on board.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Qualifying sea service declaration - Master <24 m NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Master <24 m task book and at least 120 days in the last 5 years working in a deck, or deck and engineering, capacity on board commercial vessels ≥7.5 m long.
  2. I have completed at least 600 days sea service while working in a deck, or deck and engineering, capacity with:
    • At least 50 per cent accrued on vessels ≥7.5m long; and
    • At least 50 per cent accrued on commercial vessels; and
    • Up to 50 per cent accrued on recreational vessels ≥5 m long
  3. I have completed more than 50 per cent of the sea service in 1 or 2 above in sheltered waters.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If more than 50 per cent of the required sea service is gained in sheltered waters, you will be issued with a Master <24 m NC certificate restricted to sheltered waters.
Qualifying sea service declaration - Master <35 m NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Master <35 m task book and at least 180 days sea service working on board commercial vessels ≥12 m long while holding a Master <24 m NC or a Mate <80m NC certificate, including 120 days as person in charge of a navigational watch.
  2. I have completed at least 360 days sea service working on board commercial vessels ≥12 m long, while holding a Master <24 m NC or a Mate <80m NC certificate, including 240 days as person in charge of a navigational watch.
  3. I have completed more than 50 per cent of the sea service in 1 or 2 above in sheltered waters.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If more than 50 per cent of the required sea service is gained in sheltered waters, you will be issued with a Master <35 m NC certificate restricted to sheltered waters.
Qualifying sea service declaration - Master <80 m NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Master <80 m task book and at least 180 days sea service working on board commercial vessels ≥24 m long, while holding a Master <35 m NC certificate, including 120 days as person in charge of a navigational watch.
  2. I have completed at least 360 days sea service working on board commercial vessels ≥24 m long, while holding a Master <35 m NC certificate, including 240 days as person in charge of a navigational watch.
  3. I have completed the AMSA approved Master <80 m task book and at least 360 days sea service working on board commercial vessels ≥24 m long, while holding a Mate <80 m NC, or other non-command certificate, as officer of the watch.
  4. I have completed at least 720 days sea service working on board commercial vessels ≥24 m long, while holding a Mate <80 m NC, or other non-command certificate, as officer of the watch.
  5. I have completed more than 50 per cent of the sea service in 1, 2, 3 or 4 above in sheltered waters.
Note:
If you have completed the AMSA approved task book, a copy of task book’s seafarers details page must be attached to this application.
Note:
If more than 50 per cent of the required sea service is gained in sheltered waters, you will be issued with a Master < 80 m NC certificate restricted to sheltered waters.
Qualifying sea service declaration - Mate <80 NC - New

Please select 'Yes' to one of the following statements and provide other information as requested:

  1. I have completed the AMSA approved Master <35 m NC task book and at least 300 days sea service while working on board commercial vessels ≥12 m long, in any deck capacity.
  2. I have completed at least 600 days sea service while working on board commercial vessels ≥12 m long, in any deck capacity.
  3. I have completed more than 50 per cent of the sea service in 1 or 2 above in sheltered waters.
Note:
If you have completed the AMSA approved task book, a copy of the task book's seafarer details page must be attached to this application.
Note:
If more than 50 per cent of the required sea service is gained in sheltered waters, you will be issued with a Mate <80 m NC certificate restricted to sheltered waters.
Qualifying sea service declaration – Revalidation

Please select 'Yes' to one of the following statements and provide other information as requested:

You must answer 'Yes’ to one of the statements below to have your certificate revalidated.
  1. I have completed at least 120 days sea service in the last 5 years as officer of the watch or undertaking engineering tasks, carrying out duties appropriate to the kind of certificate I am holding.
  2. I have completed at least 60 days sea service in the last 6 months.
  3. I have completed an approved revalidation course. (Currently there is no approved revalidation course).
  4. I have completed an approved final assessment.
  5. I have completed at least 120 days sea service in the last 5 years working in a seasonal fishery as a seasonal fisher (e.g. an abalone fisher).
  6. Since my certificate was first issued, or last revalidated, I have completed the AMSA approved task book for the certificate I am holding.
  7. I have other approved industry experience (such as State or Territory marine safety agency assessor or operational employee, fleet manager, shore-side servicing, teaching at a registered training organisation for maritime studies, marine surveyor, etc.).
Change of name declaration

Please respond to the following statements and provide other information as requested:

  1. I wish to change my name as recorded on my certificate to that in the applicant details section of this application.


    Please provide your previous name in the box below:



    Note:
    A copy of a certificate or document attesting to this change must be attached to this application.

Replacement declaration

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

  1. I require a replacement certificate because I have lost my current certificate.
  2. I require a replacement certificate because my current certificate has been stolen.
  3. I require a replacement certificate because my current certificate has been destroyed.
  4. I require a replacement certificate because of other reasons.


    If you answered 'Yes' to any of the statements above please provide further details in the box below:
Endorsement declaration - Coxswain Grade 2 NC
Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to apply for an endorsement to command a vessel that is carrying passengers.
To receive the endorsement, you must answer 'Yes' to statement 1 and 'Yes' to either statement 2 or 3 below:
  1. I hold a first aid certificate of at least HLT Health Training Package unit of competency Provide first aid or an equivalent certificate approved by AMSA.
  2. I have completed the AMSA approved Coxswain Grade 2 task book and at least 30 days sea service on commercial vessels ≥5 m long while working in a deck, or a deck and engineering, capacity on board.
  3. I have completed at least 240 days sea service on vessels ≥5 m long while working in a deck, or a deck and engineering, capacity on board.
Note:
If you have completed a task book you must attach a copy of the task book’s seafarer details page to this application.

I wish to apply for an endorsement to command a vessel with inboard propulsion power up to 500 kW.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have completed the Coxswain Grade 1 NC engineering units of the maritime training package.
Note:
If Coxswain Grade 1 NC engineering units of the MAR Maritime Training Package are completed, you must attach a copy of a certificate or document that shows their completion and you will be issued with a Coxswain Grade 2 NC certificate endorsed to command a vessel with inboard diesel engine of propulsion power up to 500 kW.
Endorsement declaration - Marine Engine Driver Grades 1, 2 and 3 NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to apply for an endorsement as a Chief Engineer on a vessel that has steam as its main method of propulsion <750kW, in the EEZ.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have completed the AMSA approved reciprocating steam powered task book and at least 100 hours sea service working on vessels with steam as the main propulsion with propulsion power <750 kW, as a general purpose hand; or assistant to an engineer, an engine driver, a chief engineer or a second engineer; and I have a basic boiler licence or a licence to operate a standard boiler issued by a State or Territory authority responsible for work health and safety legislation.
Note:
If you answered 'Yes' to the statement above, you must attach a copy of the task book’s seafarer details page and the basic boiler licence to this application. You will also be required to pass a final assessment.

I wish to apply for an endorsement as a Chief Engineer on a vessel, mentioned in the endorsement, that has steam as its main method of propulsion <750 kW, in the EEZ.
To receive the endorsement, you must provide the name of the vessel(s) and answer 'Yes' to the following statement:
  1. Name(s) of vessel(s)
  2. I have completed the AMSA approved specific tasks for the vessel(s) in the reciprocating steam powered task book and at least 100 hours sea service working on vessels with steam as the main propulsion with propulsion power <750 kW, as a general purpose hand; or assistant to an engineer, an engine driver, a chief engineer or a second engineer; and I have a basic boiler licence or a licence to operate a standard boiler issued by a State or Territory authority responsible for work health and safety legislation.
Note:
If you answered 'Yes' to the statement above, you must attach a copy of the task book’s seafarer details page and the basic boiler licence to this application. You will also be required to pass a final assessment.
Endorsement declaration - Engineer Class 3 NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to apply for an endorsement as a chief engineer on a vessel that has steam as its main method of propulsion <750kW, in the EEZ.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have completed the AMSA approved reciprocating steam powered task book and at least 100 hours sea service working on vessels with steam as the main propulsion with propulsion power <750 kW, as a general purpose hand; or assistant to an engineer, an engine driver, a chief engineer or a second engineer; and I have a basic boiler licence or a licence to operate a standard boiler issued by a State or Territory authority responsible for work health and safety legislation.
Note:
If you answered 'Yes' to the statement above, you must attach a copy of the task book’s seafarer details page and the basic boiler licence to this application. You will also be required to pass a final assessment.

I wish to apply for an endorsement as a chief engineer on a vessel, mentioned in the endorsement, that has steam as its main method of propulsion <750 kW, in the EEZ.
To receive the endorsement, you must provide the name of the vessel(s) and answer 'Yes' to the following statements:
  1. Name(s) of vessel(s)
  2. I have completed the AMSA approved specific tasks for the vessel(s) in the reciprocating steam powered task book and at least 100 hours sea service working on vessels with steam as the main propulsion with propulsion power <750 kW, as a general purpose hand; or assistant to an engineer, an engine driver, a chief engineer or a second engineer; and I have a basic boiler licence or a licence to operate a standard boiler issued by a State or Territory authority responsible for work health and safety legislation.
Note:
If you answered 'Yes' to the statement above, you must attach a copy of the task book’s seafarer details page and the basic boiler licence to this application. You will also be required to pass a final assessment.

I wish to apply for an endorsement as Engineer Class 3 (STCW III/3) NC: Chief Engineer on a vessel with propulsion power <3000 kW in the EEZ.
To receive the endorsement, you must answer 'Yes' to statements 1 and 2 below and 'Yes' to either statement 3 or 4:
  1. I have a Certificate of Safety Training issued by AMSA.
  2. I have an Advanced Fire Fighting Certificate issued by a training organisation approved under Marine Order 70 (Seafarer certification) 2014.
  3. I have a Diploma of Maritime Operations (Marine Engineering Class 3 Near Coastal) from the MAR Maritime Training Package, issued by a registered training organisation, or equivalent approved by AMSA.
  4. Since my certificate was first issued, or last revalidated, I have completed the Engineer Class 3 approved task book.
Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Note:
If you answered 'Yes' to statement 4, and 'No' to statement 3, you will also be required to pass a final assessment.
Endorsement declaration - Master (Inland waters)

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to apply for an endorsement to be second in command of a commercial vessel <80 m long.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have completed Part 2 of the AMSA approved Master (Inland waters) task book and worked for at least 7 days under supervision on a commercial vessel ≥24 m long operating in inland waters; while holding a Master (Inland waters) certificate of competency.
Note:
If you have completed a task book you must attach a copy of the task book’s seafarer details page to this application.
I wish to apply for an endorsement to command a commercial vessel <80 m long in inland waters.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have completed Part 3 of the AMSA approved Master (Inland waters) task book and worked for at least 14 days under supervision on a commercial vessel ≥24 m long operating in inland waters, while holding a Master (Inland waters) certificate.
Note:
If you have completed a task book you must attach a copy of the task book’s seafarer details page to this application.
Endorsement declaration - Master <24 m NC

Please respond to the following statements and provide other information as requested:

I wish to apply for an endorsement to command a domestic commercial vessel, <80 m long operating in inland waters.
To receive endorsement, you must answer 'Yes' to following the statement.
  1. I have completed Part 3 of the AMSA approved Master (Inland waters) task book and worked for at least 7 days under supervision on a domestic commercial vessel ≥24 m long, operating in inland waters; while holding a Master <24 m NC certificate of competency.
Note:
You must attach a copy of the task book’s seafarer details page to this application.
Endorsement declaration - Master <35 m NC
I wish to apply for an endorsement to command a domestic vessel <45 m long in waters to the outer limits of the EEZ.
To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have at least 120 days sea service in charge of a navigational watch on commercial vessels ≥24 m long, while holding a Master <35 m certificate of competency or equivalent certificate approved by AMSA.
Endorsement declaration - Master <80 m

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to apply for an endorsement as Master <80 m (Master <500 GT STCW Reg II/3) NC to:
  1. Command a commercial vessel <80 m long in the EEZ; or to be a
  2. Chief Mate or Deck Watchkeeper on a vessel <80 m long in the EEZ.
To receive the endorsement, you must answer 'Yes' to statements 1 and 2 below and 'Yes' to either statement 3 or 4 below:
  1. I have a Certificate of Safety Training issued by AMSA.
  2. I have an Advanced Fire Fighting Certificate issued by a training organisation approved under Marine Order 70 (Seafarer certification) 2014.
  3. I have a Diploma of Maritime Operations (Master up to 80 metres Near Coastal) from the MAR Maritime Training Package, issued by a registered training organisation, or equivalent approved by AMSA.
  4. Since my certificate was first issued, or last revalidated, I have completed the Master <80 approved task book.
Note:
If you answered 'Yes' to statement 4, and 'No' to statement 3, you will also be required to pass a final assessment.

I wish to apply for an endorsement to command, or be Chief Mate or Deck Watchkeeper of, a domestic commercial vessel <100 m long and <3000 GT in waters to the outer limits of the EEZ.

To receive the endorsement, you must answer 'Yes' to the following statement:
  1. I have at least 20 days sea service in charge of a navigational watch on domestic commercial vessels ≥80 m long.
I declare that:
  • To the best of my knowledge the information provided by me in this application, and any attachments I have included with this application, is true and correct.
  • I have checked that all of the required supporting documents are attached to this application form.
  • I understand and acknowledge that a person is guilty of an offence under section 137.1 of the Criminal Code Act 1995 if the person gives false or misleading information, or omits anything without which the information is misleading to a Commonwealth entity; a person who is exercising powers or performing functions under a law of the Commonwealth, or the information is given in compliance or purported compliance with a law of the Commonwealth.
  • I understand that the provision of false or misleading information in this application, and in any attachments I have included with this application, may result in the revocation of my certificate of competency.
  • I consent to the Australian Maritime Safety Authority making all reasonable enquiries in order to verify that the information provided by me in this application (and any attachments I have included with this application) is true and correct.
  • I understand and acknowledge that the Australian Maritime Safety Authority may ask that I provide any information or document that the National Regulator reasonably considers necessary for consideration of this application.
  • I understand and acknowledge that the Australian Maritime Safety Authority may ask another person to provide any information, document or agreement that is considered reasonably necessary for consideration of this application.
Trans-Tasman recognition declaration

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

  1. Are you subject to any disciplinary proceedings in Australia or New Zealand, including any preliminary investigations or action that might lead to disciplinary proceedings, in relation to your occupation as a seafarer?
  2. Is your registration (that is, your entitlement to carry out a seafarer occupation) cancelled or currently suspended as a result of disciplinary action in Australia or New Zealand?
  3. Are you otherwise personally prohibited from carrying on the occupation of a seafarer anywhere in Australia or New Zealand, and are you subject to any special conditions in carrying on the occupation of a seafarer, as a result of criminal, civil or disciplinary proceedings in any State or Territory?
  4. Are you subject to any special conditions in carrying on the seafarer occupation in Australia or New Zealand?
If you answered 'Yes' to any of the questions above, please provide further details in the box below:

Restriction removal declaration - Coxswain Grade 1 NC
Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove the restriction, you must answer 'Yes' to the following statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.
Note:
A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.


I wish to remove a sheltered waters restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Coxswain Grade 1 task book and at least 15 days sea service on commercial vessels ≥5 m long operating to seaward of sheltered waters while working in a deck, or deck and engineering, capacity on board.
  2. I have completed at least 120 days sea service on vessels ≥5 m long operating to seaward of sheltered waters while working in a deck, or deck and engineering, capacity on board.
Note:
Sea service on a commercial vessel ≥4.5 m long while operating beyond sheltered waters within 5 nautical miles from the point of departure, shore base or aquaculture lease is considered equivalent for the above purposes.
Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.

I wish to remove a <100 kW inboard propulsion restriction.
To remove the restriction, you must answer 'Yes' to the following statement:
  1. I have completed all of the Coxswain Grade 1 NC engineering units of the maritime training package.
Restriction removal declaration – Coxswain Grade 2 NC and Master (Inland waters)

Please respond to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove the restriction you must answer 'Yes' to the following statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate, or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.
Note:
A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.
Restriction removal declaration - Marine Engine Driver Grade 3 NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove an outboard engines only restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Marine Engine Driver Grade 3 task book and at least 10 days sea service on commercial vessels with inboard diesel engines with propulsion power ≥75 kW.
  2. I have completed at least 30 days sea service on vessels with inboard diesel engines with propulsion power ≥75 kW.
Note:
The qualifying sea service must be completed as a general purpose hand or carrying out permitted duties of a Coxswain Grade 1 NC or Coxswain Grade 2 NC, or as assistant to an engine driver, to a chief engineer or to a second engineer.
Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Restriction removal declaration - Master <24 m NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove restriction, you must answer 'Yes' to the following statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

Note:
A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.

I wish to remove a sheltered waters restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Master <24 m task book and at least 60 days sea service in the last 5 years working in a deck, or deck and engineering, capacity on board commercial vessels ≥7.5 m long operating to seaward of sheltered waters.
  2. I have completed at least 300 days sea service on vessels operating to seaward of sheltered waters while working in a deck, or deck and engineering, capacity with:
    • At least 50% accrued on vessels ≥7.5m long; and
    • At least 50% accrued on commercial vessels; and
    • Up to 50% accrued on recreational vessels ≥5 m long.
Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Restriction removal declaration - Master <35 m NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove restriction, you must answer 'Yes' to following the statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.
    • Note:
      A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.

I wish to remove a sheltered waters restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Master <35 m task book and at least 90 days sea service working on board commercial vessels ≥12 m long operating to seaward of sheltered waters, including 60 days as person in charge of a navigational watch.
  2. I have completed at least 180 days sea service working on board commercial vessels ≥12 m long, operating to seaward of sheltered waters, including 120 days as person in charge of a navigational watch.
Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Restriction removal declaration - Master <80 m NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove restriction, you must answer 'Yes' to following the statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

Note:
A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.

I wish to remove a sheltered waters restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Master <80 m task book and at least 90 days sea service working on board commercial vessels ≥24 m long operating to seaward of sheltered waters, including 60 days as person in charge of a navigational watch;
  2. I have completed at least 180 days sea service working on board commercial vessels ≥24 m long, operating to seaward of sheltered waters including 120 days as person in charge of a navigational watch;
  3. I have completed the AMSA approved Master <80 m task book and at least 180 days sea service working as officer of the watch on board commercial vessels ≥24 m long operating to seaward of sheltered waters;
  4. I have completed at least 360 days sea service working on board commercial vessels ≥24 m long as officer of the watch, operating to seaward of sheltered waters.

Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Restriction removal declaration - Mate <80 m NC

Please answer 'Yes' or 'No' to the following statements and provide other information as requested:

I wish to remove a daylight hours restriction.
To remove the restriction, you must answer 'Yes' to the following statement:
  1. I have been examined by an optometrist, ophthalmologist or medical practitioner who has issued a certificate or statement attesting that I suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

Note:
A copy of the certificate or statement provided by the optometrist, ophthalmologist or medical practitioner must be attached to this application.

I wish to remove a sheltered waters restriction.
To remove the restriction, you must answer 'Yes' to one of the following statements:
  1. I have completed the AMSA approved Master <35 m NC task book and at least 150 days sea service while working in any deck capacity on board commercial vessels ≥12 m long operating to seaward of sheltered waters.
  2. I have completed at least 300 days sea service while working in any deck capacity on board commercial vessels ≥12 m long operating to seaward of sheltered waters.

Note:
If you have completed the AMSA approved task book, a copy of the task book’s seafarer details page must be attached to this application.
Attachments – Coxswain Grade 1 NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Eyesight Test Certificate (AMSA 542).
  5. Marine Radio Operators VHF Certificate of Proficiency or equivalent or higher certificate.
  6. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
Attachments – Coxswain Grade 1 NC – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

If you are wishing to have a daylight hours only restriction removed, you must also attach copies of the following documents to this application form:

  1. Eyesight Test Certificate (AMSA 542).
    If you do not meet the colour vision requirements of the eyesight test, you must also attach a statement from an optomotrist, opthalmologist or medical practitioner attesting that you suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

If you are wishing to have a sheltered waters restriction removed you must also attach copies of the following documents to this application form:

  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
If you are wishing to have the <100kW inboard propulsion restriction lifted, you must also attach a copy of a certificate showing completion of the Coxswain Grade 1 NC engineering units of the maritime training package.
Attachments – Coxswain Grade 2 NC – Change personal details

Copies of the following current and valid documents must be attached to this application form:

  1. Certificate or document attesting to the requested change.
  2. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
    If you currently hold a passenger endorsement and you wish to retain it, you must also attach a copy of a current and valid Provide first aid certificate (HLTAID003 unit of competency) or equivalent
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
Attachments – Coxswain Grade 2 NC - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all restrictions and endorsements).
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

If you wish to receive a passenger endorsement, you must also attach copies of the following documents to this application form:

  1. Provide first aid certificate (HLTAID0003 unit of competency).
  2. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
If you wish to receive a 500 kW endorsement you must also attach a copy of a certificate or document that shows completion of the Coxswain Grade 1 NC engineering units of the maritime training package.
Attachments – Coxswain Grade 2 NC - Equivalence

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
    If you currently hold a passenger endorsement and you wish to retain it, you must also attach a copy of a current and valid Provide first aid certificate (HLTAID003 unit of competency) or equivalent
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Coxswain Grade 2 NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Eyesight Test Certificate (AMSA 542).
  4. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
  • If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
  • If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
  • If you are applying for an endorsement to carry passengers you must have completed 30 days sea service with a task book or 240 days without and must also attach a copy of a valid Provide first aid certificate (HLTAID0003 unit of competency).

Attachments – Coxswain Grade 2 NC – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Eyesight Test Certificate (AMSA 542).
  3. If you currently hold a passenger endorsement and you wish to retain it, you must also attach a copy of a current and valid Provide first aid certificate (HLTAID003 unit of competency) or equivalent
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you do not meet the colour vision requirements of the eyesight test, you must also attach a statement from an optometrist, ophthalmologist or medical practitioner attesting that you suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

Attachments – Coxswain Grade 2 NC - Revalidation

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
    If you currently hold a passenger endorsement and you wish to retain it, you must also attach a copy of a current and valid Provide first aid certificate (HLTAID003 unit of competency) or equivalent
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Coxswain Grade 2 NC - Replacement
  1. If you currently hold a passenger endorsement and you wish to retain it, you must also attach a copy of a current and valid Provide first aid certificate (HLTAID003 unit of competency) or equivalent
  2. If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
  3. If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
  4. If possible, please also attach a copy of the certificate of competency being replaced, showing all conditions, restrictions and endorsements.

Attachments – Marine Engine Driver Grade 1 NC - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  5. Seafarer details page from an AMSA approved task book that is at least 80% complete.
  6. Basic boiler licence issued by a State or Territory authority.
  7. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.

Attachments – Marine Engine Driver Grade 1 NC and Engineer Class 3 NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course certificate applicable to the certificate of competency.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  5. Current certificate of competency (clearly showing all conditions, restrictions and endorsements) or workshop skill equivalent qualification.
  6. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarers details page from an AMSA approved task book that is at least 80% complete.
    If you currently hold a certificate of competency, you must also attach a copy of that certificate to this application.
    If you hold a workshop skill equivalent qualification, you must also attach a copy of that qualification to this application.

Attachments – Marine Engine Driver Grade 2 and 3 NC - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Seafarer details page from an AMSA approved task book that is at least 80% complete.
  4. Basic boiler licence issued by a State or Territory authority.
  5. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Marine Engine Driver Grade 2 NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Eyesight Test Certificate (AMSA 542).
  5. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
  6. Current certificate of competency (clearly showing all conditions, restrictions and endorsements) or workshop skill equivalent qualification.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you currently hold a certificate of competency, you must also attach a copy of that certificate to this application.
    If you hold a workshop skill equivalent qualification, you must also attach a copy of that qualification to this application.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.

Attachments – Marine Engine Driver Grade 3 NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Eyesight Test Certificate (AMSA 542).
  5. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.

Attachments – Marine Engine Driver Grade 3 NC – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Engineer Class 3 - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
 

If you are requiring a steam endorsement, copies of the following current and valid documents must also be attached to this application form:

  1. Seafarers details page from an AMSA approved task book that is at least 80% complete.
  2. Basic boiler licence issued by a State or Territory authority.
  3. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
 

If you are requiring a STCW III/3 endorsement, copies of the following current and valid documents must also be attached to this application form:

  1. Certificate of Safety Training issued by AMSA.
  2. Advanced Fire Fighting Certificate issued by a training organisation approved under Marine Order 70 (Seafarer certification) 2014.
  3. Seafarer details page from an AMSA approved task book that is at least 80% complete.
  4. Diploma of Maritime Operations (Marine Engineering Class 3 Near Coastal).
  • Record of Sea Service Form(s) (AMSA 771); or
  • AMSA approved sea service log book or task book record of service page(s); or
  • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
  • AMSA letter of sea service assessment.
Attachments – General Purpose Hand NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course certificate applicable to the certificate of competency.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Eyesight Test Certificate (AMSA 542).
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.

Attachments – High complexity – Change of name

It is a requirement that copies of the following current and valid documents must be attached to this application form:

  1. Certificate or document attesting to the requested change.
  2. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  5. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
Attachments – High complexity - Equivalence

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).

A copy of at least one of the following documents must also be attached to this application form:

  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    • or
  2. Approved revalidation course certificate; or
  3. Approved final assessment certificate; or
  4. Seafarer details page from an AMSA approved task book that is at least 80% complete: or
  5. Evidence of approved industry experience.
Attachments – High complexity - Replacement

Copies of the following current and valid documents must be attached to this application form:

  1. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  2. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  3. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  4. If possible, please also attach a copy of the certificate of competency being replaced, showing all conditions, restrictions and endorsements.

Attachments – High complexity – Trans-Tasman recognition

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all restrictions and endorsements).
  2. Certificate of Medical Fitness for a Marine Qualification (AMSA 559).
  3. Eyesight Test Certificate (AMSA 542).
  4. Evidence of New Zealand permanent residency or citizenship.

Attachments – Low complexity – Change of name

It is a requirement that copies of the following current and valid documents must be attached to this application form:

  1. Certificate or document attesting to the requested change.
  2. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
Attachments – Low complexity - Equivalence

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
Attachments – Low complexity - Replacement

Copies of the following current and valid documents must be attached to this application form:

  1. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
    If possible, please also attach a copy of the certificate of competency being replaced, showing all conditions, restrictions and endorsements.

Attachments – Low complexity – Trans-Tasman recognition

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all restrictions and endorsements).
  2. Evidence of New Zealand permanent residency or citizenship.
  3. If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
  4. If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA542) must be attached to this application.

Attachments – Master (Inland waters) - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Seafarer details page from an AMSA approved task book that is at least 80% complete.
  4. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Master (Inland waters) - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Eyesight Test Certificate (AMSA 542).
  5. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.

Attachments – Master (Inland waters) – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Eyesight Test Certificate (AMSA 542).
    If you do not meet the colour vision requirements of the eyesight test, you must also attach a statement from an optometrist, ophthalmologist or medical practitioner attesting that you suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
Attachments – Master <24 m NC - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Seafarer details page from an AMSA approved Master (Inland waters) task book Part 3 that is at least 80% complete.
  4. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.
Attachments – Master <24 m NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course completion certificate or interim certificate of competency.
  2. Cover page of completed AMSA Mandated Practical Assessment.
  3. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  4. Marine Radio Operators Certificate of Proficiency; or equivalent or higher certificate.
  5. Eyesight Test Certificate (AMSA 542).
  6. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
    If you answered 'Yes' to any question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.


Attachments – Master <24 m NC – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

If you are wishing to have a daylight hours restriction removed, you must also attach copies of the following documents to this application form:

  1. Eyesight Test Certificate (AMSA 542).
    If you do not meet the colour vision requirements of the eyesight test, you must also attach a statement from an optomotrist, opthalmologist or medical practitioner attesting that you suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

If you are wishing to have a sheltered waters restriction removed you must also attach copies of the following documents to this application form:

  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.
Attachments – Master <35 m - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  5. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
Attachments – Master <35 m, Mate <80 m and Master <80 m NC – Remove restriction

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).

If you are wishing to have a daylight hours only restriction removed, and you do not meet the colour vision requirements of the eyesight test, you must also attach a copy of a statement from an optometrist, ophthalmologist or medical practitioner attesting that you suffer no greater abnormality in colour vision than could be tested by the Ishihara Test.

If you are wishing to have a sheltered waters restriction removed you must also attach copies of the following documents to this application form:

  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.

If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.


Attachments – Master <35 m NC and Master <80 m NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course certificate applicable to the certificate of competency.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Marine Radio Operators Certificate of Proficiency; or equivalent or higher certificate.
  4. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  5. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  6. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  7. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.

Attachments – Master <80 m - Endorsement

Copies of the following current and valid documents must be attached to this application form:

  1. Current certificate of competency (clearly showing all conditions, restrictions and endorsements).
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
If you are requiring a Master <500 GT STCW Reg II/3 endorsement, copies of the following current and valid documents must also be attached to this application form:
  1. Certificate of Safety Training issued by AMSA.
  2. Advanced Fire Fighting Certificate issued by a training organisation approved under Marine Order 70 (Seafarer certification) 2014
  3. Diploma of Maritime Operations (Master up to 80 m Near Coastal).
  4. Seafarer details page from an AMSA approved task book that is at least 80% complete.
If you are requiring a <100 m long and <3000 GT endorsement, copies of the following current and valid documents must also be attached to this application form:
  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
Attachments – Mate <80 m NC - New

Copies of the following current and valid documents must be attached to this application form:

  1. Registered training organisation (RTO) course certificate applicable to the certificate of competency.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Marine Radio Operators Certificate of Proficiency; or equivalent or higher certificate.
  4. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  5. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).
  6. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    If you have completed a task book, you must also attach a copy of the seafarer details page from an AMSA approved task book that is at least 80% complete.

Attachments - Revalidation

Copies of the following current and valid documents must be attached to this application form:

  1. Both sides of current certificate of competency, clearly showing all conditions, restrictions and endorsements.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
    If you answered 'Yes' to any question other than the eyesight question in the medical declaration, a copy of a current and valid Certificate of Medical Fitness for a Marine Qualification (AMSA 559) must be attached to this application.
    If you answered 'Yes' to the eyesight question in the medical declaration, a copy of a current and valid Eyesight Test Certificate (AMSA 542) must be attached to this application.

Attachments – Revalidation

Copies of the following current and valid documents must be attached to this application form:

  1. Both sides of current certificate of competency, clearly showing all conditions, restrictions and endorsements.
  2. Provide first aid certificate (HLTAID003 unit of competency) or equivalent.
  3. Certificate of Medical Fitness for a Marine Qualification (AMSA 559) or Certificate of Medical Fitness (AMSA 303).
  4. Eyesight Test Certificate (AMSA 542) or Certificate of Medical Fitness (AMSA 303).

A copy of one of the following documents must also be attached to this application form:

  1. Evidence in support of the declaration of sea service. This may take the form of:
    • Record of Sea Service Form(s) (AMSA 771); or
    • AMSA approved sea service log book or task book record of service page(s); or
    • Letter(s) signed by the master or owner of a vessel attesting to the sea service; or
    • AMSA letter of sea service assessment.
    • or
  2. Approved revalidation course certificate; or
  3. Approved final assessment certificate; or
  4. Seafarer details page from an AMSA approved task book that is at least 80% complete; or
  5. Evidence of approved industry experience.
PAYMENT
Certificate:
Action:
TOTAL FEE PAYABLE:
APPLICANT (PERSONAL) DETAILS
Seafarer identification number
(if not known insert N/A)
Type of certificate currently held
(insert "N/A" if you hold no certificate)
Type of certificate currently held
(insert "N/A" if you hold no certificate)
Certificate Number
(insert "N/A" if you hold no certificate)
Title
Title
Surname
Given names
Date of birth
Nationality
Phone - primary
Phone - other
Email
Street number and name
Town/suburb
State
State
Postcode
Country
Delivery address ( Same as street address )
Town/suburb
State
State
Postcode
Country
DECLARATION AND CONSENT
I declare that:
  • To the best of my knowledge the information provided by me in this application, and any attachments I have included with this application, are true and correct.
  • I have checked that all the required supporting documents are attached to this application form.
  • I understand and acknowledge that a person is guilty of an offence under section 137.1 of the Criminal Code Act 1995 if the person gives false or misleading information, or omits anything without which the information is misleading, to a Commonwealth entity, to a person who is exercising powers or performing functions under a law of the Commonwealth, or in compliance or purported compliance with a law of the Commonwealth.
  • I understand that the provision of false or misleading information in this application, and in any attachments I have included with this application, may result in the revocation of my certificate of competency.
  • I consent to the Australian Maritime Safety Authority making all reasonable enquiries in order to verify that the information provided by me in this application (and any attachments I have included with this application) is true and correct.
  • I understand and acknowledge that the Australian Maritime Safety Authority may ask that I provide any information or document that the National Regulator reasonably considers necessary for consideration of this application.
  • I understand and acknowledge that the Australian Maritime Safety Authority may ask another person to provide any information, document or agreement that is considered reasonably necessary for consideration of this application.
Signature
Name
Date
HOW TO LODGE
Lodge your completed application and attachments at an AMSA contracted Australia Post outlet. Locations of contracted Australia Post outlets can be found at Australia Post Outlets.
AMSA Privacy Statement
The collection of information requested in this form is required or authorised by Schedule 1 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (the Act). It will be used for purposes related to the Act and may be provided to Commonwealth or State / Territory government agencies for the purposes of marine safety. Failure to provide the information may result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how your information may be used or disclosed for purposes beyond those described in this statement, visit www.amsa.gov.au/privacy/.

Australia Post Privacy Statement
Australia Post is acting as an agent for the Australian Maritime Safety Authority (AMSA). The information requested on this form is being collected by Australia Post for use by AMSA. Your application will not be able to be processed if you do not provide this information. Your personal information is managed in accordance with Australia Post’s privacy policy which is available at auspost.com.au.. Australia Post may only disclose the information provided by you if required or authorised by law, or in accordance with our privacy policy. You may obtain access to your personal information by contacting the Privacy Contact Officer, Australia Post, GPO Box 1777, Melbourne Vic 3001 or visit auspost.com.au.

Aus Post
PostPay Bar Code


PROOF OF IDENTITY

Proof of identity documents must be presented to Australia Post at the time of lodging your application These MUST be original documents.
For details of the proof of identity requirements go to www.amsa.gov.au.

Your photograph will be taken upon lodgement of your application at Australia Post at no extra cost to you.

C of C Applicant Photo
Photograph to be attached by
Australia Post

Proof of identity verified by Australia Post

Australia Post officer name

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Australia Post officer signature

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Date

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Australia Post location code

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AMSA form: 426
Version: 1.1.0.1 7/18