APPLICATION FOR EXAMINATION (LEVEL 3 ASSESSMENT) FOR A CERTIFICATE OF COMPETENCY

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1 APPLICATION FOR EXAMINATION (LEVEL 3 ASSESSMENT) FOR A CERTIFICATE OF COMPETENCY ROTATION No : ATTEMPT No : A. PERSONAL PARTICULARS OF APPLICANT SURNAME:... FIRST NAMES:... DATE OF BIRTH:...COUNTRY OF BIRTH:... NATIONALITY:...I.D./PASSPORT NO.: HEIGHT:... EYE COLOUR:... HAIR COLOUR:... PERMANENT ADDRESS: TELEPHONE NO.:... PORT: GENDER M F RACE B W C I HOME PROVINCE:.. HOME LANGUAGE.... SIGNATURE OF CANDIDATE Application for level 3 assessment; issue Certificate of Competency 1 of 13

2 B. CERTIFICATE OF COMPETENCY REQUIRED STCW 78 AS AMENDED Master Chief Engineer Officer Chief Mate Chief Engineer Officer (< 3000 kw) Chief Mate (< 3000GT) Deck Officer 2 nd Engineer Officer Master (< 200GT) 2 nd Engineer Officer (< 3000 kw) Master (< 500GT) Engineer Officer Master (< 3000GT) Endorsement Chief Engineer Officer (< 750 kw) Master (< 200GT near coastal) Master (< 500GT near coastal) Mate (< 500GT) Endorsement Chief Engineer Officer (< 3000 kw) Mate (< 500GT near coastal) Endorsement Chief Mate (<3000 GT) Endorsement Master (<3000 GT) Endorsement Master (<500 GT) STCW-F Deck Officer fishing (< 24m) Chief Engineer (fishing) Deck Officer fishing ( 24m) Chief Engineer (< 3000 kw fishing) Skipper fishing (< 24m limited waters) 2 nd Engineer (fishing) Skipper fishing (< 24m unlimited waters) Skipper fishing ( 24m limited waters) Skipper fishing ( 24m unlimited waters) NON-STCW 78 Master (Port Master (< 1600GT Port Skipper (< 200GT Port Chief Engineer Officer (Port Chief Engineer Officer (< 750kW Port Chief Engineer Officer (< 1500kW Port Grade 2 Grade 1 Higher Grade Endorsement Chief Engineer Officer (<1500kW Port Endorsement Chief Engineer Officer (Port Note: Clerks must enquire if a candidate holds an additional endorsement for passenger, tanker or security when collecting the required documentation stated in tables that follow Application for level 3 assessment; issue Certificate of Competency 2 of 13

3 Master Master (< 200GT) Master (< 500GT) Master (< 3000GT) Chief Mate Chief Mate (< 3000GT) Deck Officer Master (< 200GT near coastal) Master (< 500GT near coastal) Mate (< 500GT) Mate (< 500GT near coastal) C. APPLICATIONS FOR CERTIFICATES OF COMPETENCY MUST BE ACCOMPANIED BY THE FOLLOWING SUPPORTING DOCUMENTATION: STCW 78 Deck Officer Certification Proof of Identity & 3 x colour passport-size photographs Medical certificate (SAMSA approved medical practitioner) SAMSA Eyesight certificate Proof of qualifying service (Discharge Book) Previous certificate of competency (if applicable) Trainee bridge watch-keeping certificate/s Bridge watch-keeping certificate/s Testimonial from Company Training Officer Certificate of results (from an accredited institution) Basic training certificate* Approved Training Record Book Medical care certificate Medical first aid course certificate Advanced firefighting course certificate Fire prevention and firefighting course certificate GMDSS General Operator Certificate Long Range (L)/ Short Range (S) Radio Certificate L S Personal Survival Techniques course certificate Personal Safety and Social Responsibilities course Electronic Navigation Systems management certificate Electronic Navigation Systems operational certificate Generic ECDIS course certificate Certificate of Proficiency Survival Craft and Rescue Boats Able Seafarer deck certificate Communication 1 certificate (Morse Code) Ship Security Officer Designated Security Duties # Previous result form (If applicable) Minimum age Note: # * Basic training is approved training in Personal Survival Techniques, Fire Prevention and Fire Fighting, Elementary First Aid and Personal Safety and Social Responsibilities as specified in the Code. One certificate needed not both Application for level 3 assessment; issue Certificate of Competency 3 of 13

4 Chief Engineer Officer Chief Engineer Officer (< 3000 kw) 2 nd Engineer Officer 2 nd Engineer Officer (< 3000 kw) Engineer Officer Chief Engineer Officer (< kw) Chief Engineer Officer (< 750 kw) Certification Endorsements STCW 78 Engineer Officer Certification Proof of identity 3 x colour passport-size photographs Medical certificate (SAMSA-approved medical practitioner) SAMSA Eyesight certificate Proof of qualifying service (Discharge Book) Previous certificate of competency (if applicable) Practical workshop training certificate from an accredited institution Watch-keeping certificate/s Certificate of results (from an accredited institution) Pre-sea/basic training certificates Approved Training Record Book Medical first-aid course certificate Fire prevention and firefighting course certificate Advanced firefighting course certificate Certificate of Proficiency in Survival Craft and Rescue Boats Personal Survival Techniques course certificate Personal Safety and Social Responsibilities course Ship Security Officer # Designated Security Duties # Previous Result form (If applicable) Minimum Age 18 # One certificate needed not both Application for level 3 assessment; issue Certificate of Competency 4 of 13

5 Deck Officer Fishing (< 24m) Deck Officer Fishing ( 24m) Skipper Fishing (< 24m limited waters) Skipper Fishing (< 24m unlimited waters) Skipper Fishing ( 24m limited waters) Skipper Fishing ( 24m unlimited waters) STCW-F Deck Officer Certification ID document or passport 3 x colour passport-size photographs Medical certificate (SAMSA-approved medical practitioner) SAMSA Eye test certificate Proof of sea service Pre-Sea Training (Safety Familiarization Training) Previous certificate of competency Certificate of results (from an accredited institution) Approved Training Record Book Medical first-aid certificate Medical care certificate Proficiency in Survival Craft and Rescue Boats Personal survival techniques Fishing safety # Fire prevention and firefighting course certificate Advanced firefighting course certificate Long Range (L)/ Short Range (S) Radio Certificate L L S L S L Communication 1 certificate (Morse Code) GMDSS* Electronic Navigation Systems management certificate Electronic Navigation Systems operational certificate Generic ECDIS course certificate $ Previous result form (If applicable) Minimum age Note: * required if candidate is sailing on vessels equipped with GMDSS equipment # required if candidate is moving into STCW-F from STCW or Port Operations, otherwise incorporated into training. $ required if vessel is fitted with ECDIS and in accordance with the safe manning certificate Application for level 3 assessment; issue Certificate of Competency 5 of 13

6 Chief Engineer (Fishing) Chief Engineer (< 3000 kw Fishing) 2 nd Engineer (Fishing) STCW-F Engineer Officer Certification ID document or passport 3 x colour passport-size photographs Medical certificate (SAMSA-approved medical practitioner) SAMSA Eyesight certificate Proof of sea service Previous certificate of competency Practical workshop training certificate from an accredited institution Trainee Watch-keeping Certificate Pre-sea Safety Awareness Training Certificate of results (from an accredited institution) Medical First-Aid course certificate Proficiency in Survival Craft and Rescue Boats Advanced Firefighting course certificate Personal Survival Techniques Previous Result form (If applicable) Minimum Age Application for level 3 assessment; issue Certificate of Competency 6 of 13

7 Master (Port Master (< 1600GT Port Skipper (< 200GT Port * Non-STCW Deck Officer Certification ID book or passport 3 x colour passport-size photographs Medical certificate (SAMSA-approved medical practitioner) SAMSA Eyesight certificate Proof of qualifying service Previous certificate of competency (if applicable) Trainee watch-keeping certificate/s Watch-keeping certificate/s Testimonial from Company Training Officer Certificate of results (from an accredited institution) Medical first-aid certificate Advanced firefighting course certificate Fire prevention and firefighting course certificate Long Range (L)/ Short Range (S) Radio Certificates S S S Electronic Navigation Systems (operational) Electronic Navigation Systems (management) Personal survival techniques certificate Personal Safety and Social Responsibilities course certificate Basic Training certificate Previous result form (If applicable) Minimum age Note: * under 200GT is a limitation for command purposes, however this column/these requirements can be used to apply for any Skipper Port Operations Certificate Application for level 3 assessment; issue Certificate of Competency 7 of 13

8 Chief Engineer Officer (Port Chief Engineer Officer (< 750kW Port Chief Engineer Officer (< 1500kW Port Grade 2 Grade 1 Higher Grade Endorsement Chief Engineer Officer (<1500kW Port Endorsement Chief Engineer Officer (Port Non-STCW Engineer Officer Certification ID document or passport 3 x colour passport-size photographs Medical certificate (SAMSA-approved medical practitioner) SAMSA Eyesight certificate Proof of sea service Previous certificate of competency Trainee Watch-keeping Certificate * * * Practical workshop training certificate from an accredited institution * * * Certificate of results (from an accredited institution) * * * Approved Training Record Book * * * Medical first-aid course certificate Fire prevention and firefighting course certificate Advanced firefighting course certificate Personal survival techniques Previous result form (If applicable) Minimum age NOTE: *this only applies to candidates who started their training or sea time after the 23 rd of July Application for level 3 assessment; issue Certificate of Competency 8 of 13

9 Deck Officer - GT Engineer Officer - Propulsion power (kw) Type of service (unlimited, nearcoastal, port operations) Engineers Steam/ Motor D. Deck and Engineer Officer sea service Particulars of sea service should be taken from the Seaman s Record Book and/or Certificate(s) of Discharge. Name of ship Type of ship Tankers LNG/ Oil/ Chemical/ Passenger/ Bulk Carriers/ Supper Yachts/ Container/ Ro-Ro/ Mining/ Off-shore supply/ Tugs/ AH vessels/ DP vessels/ Rank Dates Actual period Assessed period For Official use only. From To Months Days Months Days Net qualifying service Date: Signature of examiner: Application for level 3 assessment; issue Certificate of Competency 9 of 13

10 FOR OFFICE USE ONLY Fee received:..receipt No.:.Date: Signature of person receiving fee... Signature of candidate I hereby certify that the particulars contained herein are correct, and that the candidate has produced satisfactory testimonials and proof of service and that the candidate has been assessed by the undersigned by means of a Level 3 examination with the following results: COMPETENT NOT YET COMPETENT a) The candidate is therefore required to serve month s approved sea service prior to application for the level 3 assessment. b) The candidate may be issued with a Certificate of Competency as: The Examiner is to complete each table by indicating the applicable CoC / CoP / Endorsement / Limitation and expiry date. STCW DECK OFFICERS References and limitations. Certificate of competency Ref. Limitations Master II/2 None Chief Mate II/2 None Master (<3000GT) II/2 Master of a ship of less than 3000GT on unlimited voyages Chief Mate (<3000GT) II/2 Chief Mate of a ship of less than 3000GT on unlimited voyages Deck Officer II/1 None Master (<500GT) II/3 Master of a ship of less than 500GT on unlimited voyages Mate (<500GT) II/3 Officer in charge of a navigational watch on a ship of less than 500GT on unlimited voyages Master (<200GT) II/3 Master of a ship of less than 200GT on unlimited voyages Master (<500GT Near- II/3 Master of a ship of less than 500GT on near-coastal voyages Coastal) Mate (<500GT Near- II/3 Officer in charge of a navigational watch on a ship of less than Coastal) 500GT on near-coastal voyages Master (<200GT Near- II/3 Master of a ship of less than 200GT on near-coastal voyages Coastal) Master (<1600GT Port Reg. 24 Master of a ship of less than 1600GT operating within a port operations area Master (Port Reg. 25 Master of a ship of any tonnage operating within a port operations area Skipper (Port Reg. 19 Master of a ship of less than 200GT operating within a port operations area Application for level 3 assessment; issue Certificate of Competency 10 of 13

11 Endorsements Ref Limitations Master (Mining II/2 Master of a ship of any tonnage engaged in mining operations Chief Mate (Mining II/2 Chief Mate of a ship of any tonnage engaged in mining operations Deck Officer (Mining II/1 Officer in charge of a navigational watch on a engaged in mining operations Master (<200GT Near- Coastal Non-Trading) II/3 Master of a ship of less than 200GT limited to non-trading vessels on near-coastal voyages Master (<200GT Non- Trading) II/3 Master of a ship of less than 200GT limited to non-trading vessels on unlimited voyages Mate (<500GT Near- Coastal Non-Trading) II/3 Officer in charge of a navigational watch on a ship of less than 500GT limited to non-trading vessels on near-coastal voyages Mate (<500GT Non- Trading) II/3 Officer in charge of a navigational watch on a ship of less than 500GT limited to non-trading vessels on unlimited voyages Master (<500GT Near- Coastal Non-Trading) II/3 Master of a ship of less than 500GT limited to non-trading vessels on near-coastal voyages Master (<500GT Non- Trading) II/3 Master of a ship of less than 500GT limited to non-trading vessels on unlimited voyages Deck Officer (Non- Trading) II/1 Officer in charge of a navigational watch on a ship of any tonnage limited to non-trading vessels on unlimited voyages Chief Mate (<3000GT Non-Trading) II/2 Chief Mate of a ship of less than 3000GT limited to non-trading vessels on unlimited voyages Master (<3000GT Non- Trading) II/2 Master of a ship of less than 3000GT limited non-trading vessels on unlimited voyages Master (Non-Trading) II/2 Master of a ship of any tonnage limited to non-trading vessels on unlimited voyages Chief Mate (Non- Trading) II/2 Chief Mate of a ship of any tonnage limited to non-trading vessels on unlimited voyages STCW-F Deck Officers Certificate Skipper Fishing ( 24m Unlimited) Skipper Fishing (<24m Unlimited) Skipper Fishing ( 24m Limited) Skipper Fishing (<24m Limited) Deck Officer Fishing (<24m) Deck Officer Fishing ( 24m) STCW-F Reference II/1 II/1 II/3 Limitations Master any ship engaged in fishing on unlimited waters Master of a ship of less than 24 metres engaged in fishing on unlimited waters Master any ship engaged in fishing on limited waters II/1 Master of a ship of less than 24 metres engaged in fishing on limited waters II/2 Officer in charge of a navigational watch on a ship of less than 24 metres engaged in fishing on unlimited waters II/2 Officer in charge of a navigational watch on any ship engaged in fishing on unlimited waters Application for level 3 assessment; issue Certificate of Competency 11 of 13

12 STCW Engineer Officers Limitations Primary Limitations Motorships Only Combined Motor and Steam Not valid to operate and maintain power systems in excess of 1000 Volts Not permitted to work on complex coloured cables Certificate Ref: Limitations Chief Engineer III/2 None Officer Second III/2 None Engineer Officer Chief Engineer Officer (<3000kW) III/3 Chief Engineer Officer of a ship of less than 3000kW propulsion power Second Engineer Officer (<3000kW) III/3 Engineer Officer III/1 None Electro- Technical Officer STCW-F Engineering Officers Second Engineer Officer of a ship of less than 3000kW propulsion power III/6 Officer in charge of electronic equipment on board a ship of 1000 Volts or more Certificate Ref Limitations III/3 Chief Engineer of any vessel <24m <350kW propulsion power Grade 2 Grade 2 III/3 Officer in charge of an engineering watch on any vessel <24m <1000kW propulsion power Grade 1 III/3 Chief Engineer of any vessel of less than 1000kW propulsion power on near-coastal or limited waters voyages Grade 1 III/3 Officer in charge of an engineering watch on any vessel of less than 2000kW propulsion power on near-coastal or limited waters Higher Grade Second Engineer Officer (Fishing) Chief Engineer Officer (<3000kW Fishing) Chief Engineer Officer (Fishing) III/3 III/3 III/3 III/3 voyages Officer in charge of an engineering watch on any vessel of less than 3000kW propulsion power on near-coastal or limited waters voyages Officer in charge of an engineering watch on fishing vessels of unlimited propulsion power Chief Engineer Officer of a fishing vessel of less than 3000kW propulsion power Chief Engineer Officer of a fishing vessel of any propulsion power Application for level 3 assessment; issue Certificate of Competency 12 of 13

13 The following Certificate(s) of Proficiency to be endorsed to the Certificate of Competency: Certificate of Proficiency STCW Reference Elementary First Aid A-VI/1-3 Medical First Aid A-VI/4-1 Medical Care A-VI/4-2 Personal Survival Techniques A-VI/1-1 Personal Safety and Social Responsibilities A-VI/1-4 Fire Prevention and Fire Fighting A-VI/1-2 Advanced Fire Fighting A-VI/3 Basic Training A-VI/1 Survival Craft and Rescue Boats A-VI/2-1 Fast Rescue Boat A-VI/2-2 Basic Training Oil and Chemical Tankers A-V/1-1-1 Basic Training Liquefied Gas Tankers A-V/1-2-1 Advanced Training Oil Tankers A-V/1-1-2 Advanced Training Chemical Tankers A-V/1-1-3 Advanced Training Liquefied Gas Tankers A-V/1-2-2 Designated Security Duties A-VI/6-2 Ship Security Officer A-VI/5 Security Awareness A-VI/6-1 Crowd Management and Passenger Safety A-V/2 Passenger Safety, Cargo Safety and Hull Integrity A-V/2 Crisis Management and Human Behaviour A-V/2 Pre-sea Safety Familiarization Training A-VI/1 Applicable Regulations Merchant Shipping (Safe Manning, Training and Certification) Regulations 2013, as amended International Convention on Standards of Training, Certification and Watchkeeping for Seafarers 78 as amended. International Convention on Standards of Training, Certification and Watchkeeping for Fishing Vessel Personnel, 1995 Level Management Operational Support N/A NB Ensure date of expiry of CoC is clearly stated for Certification Section. Signature of examiner: Port:. Name of examiner:.. Date: Application for level 3 assessment; issue Certificate of Competency 13 of 13

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