Australian Government - Australian Maritime Safety Authority

AMSA forms

APPLICATION FOR CLIENT INITIATED SUSPENSION OR SURRENDER OF MARINE SURVEYOR ACCREDITATION – AMSA 899
Marine Safety (Domestic Commercial Vessel) National Law Act 2012
Marine Safety (Domestic Commercial Vessel) National Law Regulation 2013
 

When to use this form

Use this form to suspend or surrender your marine surveyor 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 160899xxxxxxxx located at the top right hand corner of the form .

Lodging your application

You must fully complete the AMSA899 form, sign, and date it. An application with missing information will not progress and will be 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
PO Box
Street
Town/suburb
State
Postcode
Country

Phone
Website
General Email

C. Details of suspension / surrender of my marine surveyor accreditation

I would like to:

Commencement date
End date (for suspension)

Section 41(1)(d) of the Marine Safety (Domestic Commercial Vessel) National Law Regulation 2013 states that the surveyor must return their identification card to the National Regulator
Please post the ID card to below address:

Australian Maritime Safety Authority
Surveyor Accreditation
PO Box 16001
Collins Street West
MELBOURNE VIC 8007


If surrendering accreditation, please indicate which category(s):


Reason for suspension or surrender of marine surveyor accreditation

Tick relevant reasons(s):

Other reason

D. Do you have any outstanding vessel surveys?


Details of partially completed survey work to be taken over by the nominated accredited marine surveyor. If more than three (3) vessels, please include additional details on a separate piece of paper.


Total vessel surveys outstanding


Vessel name 1
Vessel UVI
MARS code(s)
Description of work completed by you to date
Date of commencement of work by the nominated accredited surveyor
dd/mm/yyyy


Vessel name 2
Vessel UVI
MARS code(s)
Description of work completed by you to date
Date of commencement of work by the nominated accredited surveyor
dd/mm/yyyy


Vessel name 3
Vessel UVI
MARS code(s)
Description of work completed by you to date
Date of commencement of work by the nominated accredited surveyor
dd/mm/yyyy

You must nominate another accredited marine surveyor to undertake any unfinished work that you have been contracted to do.

E. Nominated accredited marine surveyor


Title (Mr, Mrs, etc.)
Surname
Given name(s)
Surveyor ID / AMSA ID
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 understand 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 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 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 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. Lodgement of application

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.
AMSA form: 899
Version: 1 5/2021