Australian Government - Australian Maritime Safety Authority

AMSA forms

APPLICATION FOR VARIATION OF CONDITIONS IN A CATEGORY OF SURVEYING – AMSA 902
Marine Safety (Domestic Commercial Vessel) National Law Act
Marine Safety (Domestic Commercial Vessel) National Law Regulation
 

When to use this form

Use this form to apply to vary any conditions placed on your existing accreditation. This may be:
  • to remove a condition
  • add or remove materials; or
  • increase of vessel length

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 160902xxxxxxxx located at the top right-hand corner of the form and on the Fee Advice located on the last page. 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 and 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 pages including Fee Advice.

What do you need to provide

You will need to provide these supporting documents:
  • A summary of your work experience relevant to the application
  • Certified copies of qualifications relevant your application
  • Evidence of continued professional development (CPD) relating to vessel building, design, engineering, or vessel survey since last accredited

If a decision is made to refuse your application, your fee will not be refunded

Lodging your application

You must submit all supporting documents at the same time you lodge this AMSA902 form. An application with missing documents will not progress and will be returned to the applicant.

Lodge by email to: dcvsurvey@amsa.gov.au
Acceptable formats of documents are pdf and jpeg.

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
Primary 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. Categories of marine surveyor accreditation

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

  1. Initial survey - plan approval
  2. initial survey – stability approval
  3. initial survey – load line – assignment
  4. initial survey – electrical – extra low voltage
  5. initial survey – electrical – low voltage
  6. initial survey – electrical – high voltage
  7. initial survey – construction or alteration – hull, deck and superstructure
  8. initial survey – construction or alteration – machinery
  9. initial survey – construction or alteration – load line conditions and markings
  10. initial survey – construction or alteration – equipment
  11. initial survey – construction or alteration – commissioning
  12. periodic survey
  13. periodic survey – electrical
  14. periodic survey – load line
  15. survey of safety equipment
  16. survey of communications equipment
D. Satisfaction of eligibility requirements

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

If more space is required, please attach a separate document with details
Yes, I am attaching a separate sheet

Category being varied
Category being varied
Vessel Name
Hull material
Hull material
Vessel Length (m)
Survey Date (dd/mm/yyyy)
Survey Type
Referee (If any of the work experience indicated was undertaken with either of your referees, please indicate their name)
Extent To involvement

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
E. Professional referees
First referee
Title (Mr, Mrs, Dr, etc.)
Surname
Given name(s)
Middle names(s)
Surveyor ID / AMSA ID
Relationship
Length of relationship
Place of employment
Position in the company
Residential address
Unit
Number
Street
Town/suburb
State
Postcode
Country
Business Phone
Preferred contact mobile
Preferred contact email
Second referee
Title (Mr, Mrs, Dr, etc.)
Surname
Given name(s)
Middle names(s)
Surveyor ID / AMSA ID
Relationship
Length of relationship
Place of employment
Position in the company
Residential address
Unit
Number
Street
Town/suburb
State
Postcode
Country
Business Phone
Preferred contact mobile
Preferred contact email
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.
  • I understand that failure to comply with a condition imposed on a category of accreditation (including the statutory conditions) for which I have applied may be grounds on which AMSA may vary, suspend, or revoke the accreditation, issue an infringement notice, or commence prosecution action.
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

In order for your application to progress, you must make the required payment of 0 in full

Please Note: Annual indexation applies to this fee, on 1 July each year

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 AMSA902 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
${AdviceDate}
Transaction Reference Number (TRN) Description Amount
${AdviceTRN} ${AdviceDescription} ${AdviceAmount}
GST $ ${AdviceGST}
Total AUD GST $ ${AdviceTotalcost}

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: 902
Version: 2 04/24