Australian Government - Australian Maritime Safety Authority

AMSA forms

APPLICATION FOR RENEWAL OF ACCREDITATION IN CATEGORY(S) OF MARINE SURVEYING – AMSA 804
Marine Safety (Domestic Commercial Vessel) National Law Act 2012
Marine Safety (Domestic Commercial Vessel) National Law Regulation 2013
 
As per Marine Safety (Domestic Commercial Vessel) National Law Regulation 2013 you are required to submit your application AMSA804, and pay the fee no less than three (3) months prior to the expiry of your accreditation.

If you are not able to submit your application three months prior to your accreditation expiring, please contact the accreditation team to discuss the options via email: dcvsurvey@amsa.gov.au.

If you do not wish to renew your accreditation, please advise us by reply email: dcvsurvey@amsa.gov.au.

When to use this form

Use this form to renew your marine surveying accreditation.

How to complete the form

Online

Type directly into the boxes and on completion, select “download pdf”. The system will generate a prefilled form with a unique AMSA Transaction Reference Number (TRN) beginning with 160804xxxxxxxx located at the top right hand corner of the form and on the fee advice. The TRN number will link your application and payment. If you make an error re-complete the form, and a new TRN number will be generated.

Print & Sign

Please ensure that you sign strictly within the box provided using a black pen. If your signature is too large to fit in the box, you may submit a separate sheet of paper with your signature. The signature box can be enlarged by clicking and dragging the bottom right hand corner of the box before printing.
Please print all seven (7) pages including the Fee Advice.

What else do you need to provide

You will need to provide supporting documents evidencing:

  1. professional association membership
  2. continued professional development
  3. photo

Payment of application

Page seven of your application is a Fee Advice, use this to make payment prior to lodgement of your application.

Lodging your application

You must submit all supporting documents at the same time you lodge the AMSA804 form. An application with missing documents will not progress and will be automatically sent back to the applicant.

Email is faster and easier: dcvsurvey@amsa.gov.au
Acceptable formats of documents are pdf and jpg.


 
A. Applicant details
Title (Mr, Mrs, Dr, etc.)
Surname
Given name(s)
Middle names(s)
Surveyor ID / AMSA ID
Residential address
Unit
Number
Street
Town/suburb
State
Postcode
Country
Postal address ( Tick if same as residential address)
Unit
Number
PO Box
Street
Town/suburb
State
Postcode
Country

Private Phone
Private Mobile
Preferred Email for correspondence with AMSA

B. Employment details
Employer / Company trading name
ACN (if applicable)
ABN (if applicable)
Address
Unit
Number
Street
Town/suburb
State
Postcode
Country

Phone
Website
General Email
 

C. Evidence of professional association membership


Tick relevant membership level:
Other
Name of Professional Association
Issue Date (dd/mm/yyyy)
Expiry Date (dd/mm/yyyy)

Some examples of evidence of current membership may be:
  • AIMS stamp showing membership level and expiry date
  • RINA letter confirming class of membership and expiry date
  • IIMS membership card
  • IMarEST membership card
  • Tax Invoice alone is not acceptable / must obtain a written statement from the association
D. Evidence of continued professional development


Some examples may include but not limited to:
  • Statement of continued professional development (CPD) from your professional association
  • or;
  • Copies of certificates relating to:
  • additional qualifications you may have attained
  • short courses/safety training
  • technical meetings/conferences/workshops
  • mentoring
  • writing publications (e.g. subscriptions to magazines)
  • webinars relevant to marine surveying
  • survey work outside of national law; or
  • surveys completed prior to the MARS system
Other
E. Photograph guidelines

  • face centred from the neck up
  • white background
  • dimensions of 45mm x 35mm (not including a border)

Attach photo as below or if scanning, it must be in high resolution of 300-600dpi.


 
F. Applicant’s 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) is true and correct.
  • 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 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 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.
Signature

You will need to PRINT the form, then sign inside the box. Please use a BLACK pen and ensure your signature fits inside the signature box.

Name
Date (dd/mm/yyyy)
 
G. Lodge and Pay

Payment

Using the seventh page of your application, make the payment either:
  • Online
  • Australia Post
  • BPay
In order for your application to progress, you must make the required payment in full.

Methods of payment

Please indicate below which method of payment was used and the paid date
Date of payment (dd/mm/yyyy)

Which TRN number was used to reference the payment?

If the TRN number is the same as indicated on the top right hand corner of the AMSA804 application form submitted, then leave blank, otherwise indicate the number below.

Where to lodge

Email 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: 65 377 938 320

Fee advice
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Transaction Reference Number (TRN) Description Amount
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GST $ ${AdviceGST}
Total AUD GST $ ${AdviceTotalcost}

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: 804
Version: 1 07/2021