MARITIME AND PORT AUTHORITY OF SINGAPORE MARITIME CLUSTER FUND (MCF) TRAINING GRANT CLAIM FORM FOR COC REVALIDATION COURSES FOR USE BY INDIVIDUALS
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1 MARITIME AND PORT AUTHORITY OF SINGAPORE MARITIME CLUSTER FUND (MCF) TRAINING GRANT CLAIM FORM FOR COC REVALIDATION COURSES FOR USE BY INDIVIDUALS INSTRUCTIONS i. Submit completed Application Form to: The MCF Secretariat Industry Manpower Development Department, IMC Division Maritime and Port Authority of Singapore 460 Alexandra Road #19-00, PSA Building, Singapore ii. Attached a copy of the following documents (all documents must bear your name) Copy of NRIC or Passport Copy of Certificate of Competency (all pages) Copy of Bank Book or Bank Statement Certificate of for each revalidation application Invoice for each revalidation application iii. iv. MCF@MPA.GOV.SG for any queries. All claims must be submitted to the MCF Secretariat within 6 months after the completion of the COC Revalidation A. PERSONAL INFORMATION Full Name : (in BLOCK LETTERS as shown in identity card) Nationality* : SINGAPORE CITIZEN / PERMANENT RESIDENT Identity Card Number : Contact Number (Home) : Contact Number (Mobile) : Address : Certificate of Competency (COC) Information COC Certificate Number : COC of Issue : COC Expiry : Bank Account Details Bank Account Number : Name of Bank : Registered Name for Bank Account : Page 1 of 6
2 Please tick here if this is your FINAL COC revalidation claim. B. COC REVALIDATION CLAIMS SUBMISSION Name Please tick if For Certificate of Competency (Deck Officer) Class 1 (Master Mariner) and Class 2 Medical First Aid and Medical Care Revalidation Certificate of Proficiency (COP) as Ship Security Officers Training Bridge Resource Management and Use of Leadership and Managerial Skillls Training at management level Certificate of Competency (Deck Officer) Class 3 Bridge Resource Management and Application of Leadership and Teamworking Skills (Operational level) Fee Paid Page 2 of 6
3 Name Please tick if Certificate of Competency (Deck Officer) Class 4 (Home-Trade Master) and Class 5 (Home Trade Mate) Medical First Aid and Medical Care Revalidation Certificate of Proficiency (COP) as Ship Security Officers Training Bridge Resource Management and Use of Leadership and Managerial Skillls Training at management level Certificate of Competency (Deck Officer) Class 5SL (Special Limit Chief Mate) Medical First Aid and Medical Care Revalidation Bridge Resource Management and Application of Leadership and Teamworking Skills (Operational level) Certificate of Competency (Deck Officer) Class 6 Security Awareness Training Fee Paid Page 3 of 6
4 Please tick if Name Certificate of Competency (Marine Engineer Officer) Class 1 & Class 2 Fee Paid Leadership and Managerial Skills (Management Level) High Voltage Installation (HVI) at Management level Certificate of Competency (Marine Engineer Officer) Class 3 & 4 Leadership and Managerial Skills (Operational Level) High Voltage Installation (HVI) at Operational level Certificate of Competency (Marine Engineer Officer) Class 4 (Special Limit) Page 4 of 6
5 Name Leadership and Managerial Skills (Management Level) High Voltage Installation (HVI) at Management level* Please tick if Fee Paid Certificate of Competency (Marine Engineer Officer) Class 5 & Class 5 Special Limit Leadership and Managerial Skills (Operational Level) High Voltage Installation (HVI) at Operational level* * If fitted Page 5 of 6
6 C. DECLARATION 1. I AFFIRM that all statements made by me on this form are correct. Any inaccurate or false information (or omission of material information) will render this application invalid and that, if admitted on the basis of such information, MPA can withdraw its grant under this scheme 2. I DECLARE that I did not receive any other forms of financial assistance administered by any government bodies e.g. MAS or WDA etc for these s 3. I FURTHER UNDERTAKE to inform the Maritime and Port Authority of Singapore immediately of any changes in the information given in this application. Signature Page 6 of 6
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