AMSA forms
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NEAR COASTAL SEA SERVICE RECORD – AMSA 771
Marine Safety (Domestic Commercial Vessel) National Law Act 2012
Marine Order 505 (Certificates of competency – national law) 2013
Seafarer / Applicant Details
Name
Date of birth
Phone number
Signature
Date of signing
Operational and vessel details
Company/business name
Position on board (eg. GPH, Master, Mate)
Vessel name
Unique vessel identifier/IMO No.
Start date
End date
Number of days (8 hrs)
Mode of operation(1)
Mode of operation(1) (only enter one)
--- Select ---
VU: Vessel Underway
NUD: Not Underway deck or refit work
NUE: Not underway engine or refit work
Type of operation(2)
--- Select ---
C: Commercial
R: Recreational
M: Military
Duties performed(3)
--- Select ---
AE: Assistant to Engineer or Engine Driver
E: Engineer or Engine Driver
EW: Engineer watchkeeper
EIC: Engineer in charge
D: Deck work
DE: Deck and Engine work
GPH: General purpose hand
INW: In charge of navigation watch / officer of watch
Coxswain grade 1, 2 or 3
Measured length (m)
Propulsion(4)
--- Select ---
I: Inboard
O: Outboard
S: Steam
COS/NS Propulsion power in kW
No of Propulsion engines
Supervisor details
Supervisor name
Position (job title)
Email
Phone
Certificate of competency held
Supervisor signature
Date
Supervisor role:
Master in charge
Engineer in charge
Owner
Other
Remove
Add
How to lodge
Lodge with AMSA 426 Form
• Ensure all duties performed are relevant to the certificate of competency applied for
• For high complexity renewal, 100% of the sea service must have been accrued in the 5 years before the application
• Use one record of sea service form 771 per vessel
• You
must
have a supervisor verify your sea service with a written or electronic signature
• If you are unable to obtain a supervisor's signature, you must support your AMSA 771 with a Commonwealth statutory declaration
Sea service reference data
Mode of operation(1) (only enter one)
Type of operation(2):
Duties performed(3):
Propulsion type(4):
VU
: Vessel Underway
NUD
: Not underway deck or refit work
NUE
: Not underway engine or refit work
C
: Commercial
R
: Recreational
M
: Military
AE
: Assistant to Engineer or Engine Driver
E
: Engineer or Engine Driver
EW
: Engineer watchkeeper
EIC
: Engineer in charge
AEIC
: Assistant to engineer in charge
D
: Deck work
DE
: Deck and engineering
GPH
: General purpose hand
INW
: In charge of navigation watch/officer of watch
C
: Coxswain Grade 1 or 2
I
: Inboard
O
: Outboard
S
: Steam
AMSA form: 771
Version:
3
3/26
