Australian Government - Australian Maritime Safety Authority
APPLICATION FOR ACCREDITATION IN A CATEGORY OF SURVEYING – AMSA 741
Marine Safety (Domestic Commercial Vessel) National Law Act 2012
Marine Safety (Domestic Commercial Vessel) Regulation 2013
 

Guidance on how to use this form

You can use this form to apply for accreditation for the first time or to apply to add categories to your accreditation.

In order to complete this form you must answer all the mandatory questions and supply the relevant information in support of your application.

When you are ready to submit the form you must click the ‘download pdf’ button at the end of this form. This will generate a form that you can then email or mail into AMSA. It will also include details on how payment can be made. Your application can not be processed until payment is received.

A. Payment
In order for your application to be assessed, you must make the required payment in full. The payment amount is indicated below. You will be notified of the payment reference and payment method(s) when you generate a printed copy of this application. You have 30 days in which to make the payment, after which you will need to submit a new application. The fee payable is an assessment fee determined by the number of categories applied for.

1 to 5 categories: 0
6 to 10 categories: 0
11 to 16 categories: 0

Cost for categories selected:
If a decision is made to refuse your application you will not be provided with a refund of the fee payable.
B. Applicant details
Title (Mr, Mrs, Dr, etc)
Surname
Given names
Date of birth
Nationality
Place of birth (town, state, country)
Street name and number
Town/suburb
State
Postcode
Postal address ( Same as street address )
Town/suburb
State
Postcode
Phone
Mobile
Email
If you have a company relating to survey, or employed by such a company

Company or trading name
ABN
ACN
C. Categories of accreditation

Please indicate the categories of accreditation in which you are applying for accreditation.

(a) Initial survey – plan approval
(i) Initial survey – construction or alteration – loadline
conditions and marking
(b) Initial survey – stability approval
(j) Initial survey – construction or alteration – equipment
(c) Initial survey – loadline - assignment
(k) Initial survey – construction or alteration – commissioning
(d) Initial survey – electrical – extra low voltage
(l) Periodic survey
(e) Initial survey – electrical – low voltage
(m) Periodic survey – electrical
(f) Initial survey – electrical – high voltage
(n) Periodic survey – loadline
(g) Initial survey – construction or alteration – hull, deck
and superstructure
(o) Survey of safety equipment
(h) Initial survey – construction or alteration – machinery
(p) Survey of communications equipment

Please indicate the size of vessels you wish to be accredited to survey:

I am seeking accreditation to survey vessels up to
m long.


Please specify the materials you are seeking accreditation to survey:
Aluminium
Steel
Timber
Fibre Reinforced Plastic
Polyethylene
Ferro cement
Other (please specify)
D. Professional referees
First referee
Title (Mr, Mrs, Dr, etc)
Surname
Given names
Length of relationship
Relationship
Place of employment and position
Street name and number
Town/suburb
State
Postcode
Postal address ( Same as street address )
Town/suburb
State
Postcode
Phone
Mobile
Email
Second referee
Title (Mr, Mrs, Dr, etc)
Surname
Given names
Length of relationship
Relationship
Place of employment and position
Street name and number
Town/suburb
State
Postcode
Postal address ( Same as street address )
Town/suburb
State
Postcode
Phone
Mobile
Email
E. Satisfaction of eligibility requirements

The following must be included with your application. Incomplete applications will not be accepted and will be returned.

    • under an ISO 9001 accredited Quality Management System for marine surveying, or equivalent management system; or
    • in accordence with the Marine Surveyors Accreditation Guidence Manual
    • This may be an ISO 9001 certificate of compliance, or letter of undertaking to operate under the Marine Surveyors Accreditation Guidence Manual.
    • An original or certified copy of a document issued to you by an Australian government department or agency that provides proof of your identity ( birth certificate, immigration papers, drivers licence, passport, etc.) or
    • a certified copy of your foreign passport.
 
F. Applicant's photograph

Include two photographs of yourself, taken within the previous six months. Attach one below and include a second with this application. Both photographs must have dimensions of 45 mm x 35 mm (not including a border), as indicated below.

G. Applicant's declaration and consent
  1. Have you ever held accreditation (however desribed) as a marine surveyor which has been suspended or revoked?
  2. Have you ever had membership of a professional association related to vessel building, vessel design, vessel engineering or vessel survey revoked, suspended or involuntary cancelled?
  3. Do you consent to Australain Maritime Safety Authority publishing your telephone number, email address and geographical areas in which you will conduct surveys in addition to your name and accredited categories on the Schedule of Accredited Marine Surveyors, which is available at www.amsa.gov.au?
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 understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, 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, as the National Regulator, may ask another person to provide any information, document or agreement that the National Regulator reasonably considers necessary for consideration of this application.
  • I consent to the Australian Maritime Safety Authority, as the National Regulator, making all reasonable enquiries in order to verify that the information provided by me in this application (and any attachments that I have included with this application) is true and correct.
Signature
Name

Please use a BLACK pen and ensure your signature fits inside the signature box

Date

Where to lodge: Australian Maritime Safety Authority, Attention: Surveyor Accreditation, PO Box 16001
Collins Street West, Melbourne VIC 8007, Australia or by e-mail to: DCVsurvey@amsa.gov.au

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.

Australian Maritime Safety Authority

ABN: 65 3777 938 320

Fee advice
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This fee advice is valid until ${AdvicePaymentExpiry} and is applicable only for the application associated with this fee advice. The assessment of your application will only commence once we have received your payment and all supporting documents. This is a non-refundable application fee and covers all the services required to process your request, however it does not guarantee that your application will be successful.

Payment details

Methods of payment

Payment via internet Payment via phone Payment via post office
AMSA: https://payments.amsa.gov.au can accept VISA or Mastercard payments only.

BPAY: Contact your bank or financial institution to make this payment from your cheque and savings transaction accounts. More information at bpay.com.au.

PostBillpay: www.postbillpay.com.au can accept VISA, Mastercard or PayPal payments only.

13 18 16 (POSTbillpay) can accept VISA or Mastercard payments only.

BPAY via your financial institution can accept cheque and savings payments only.

Payment can be made at any Australian Post Office within Australia by cheque, cash, EFTPOS, VISA or Mastercard.

The post office will issue you a receipt.

AMSA form: 741
Version: 1 7/18