Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 1 of 13 FOP-513
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: ...
E-MAIL: ...
E-MAIL: ...
………...
SIGNATURE OF CANDIDATE
GENDER M F RACE B W C I HOME PROVINCE: ………..
HOME LANGUAGE ……….
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 2 of 13 FOP-513
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 2nd Engineer Officer
Master (< 200GT) 2nd 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) 2nd Engineer (fishing) Skipper fishing (< 24m unlimited waters)
Skipper fishing (≥ 24m limited waters) Skipper fishing (≥ 24m unlimited waters) NON-STCW’78
Master (Port Operations)
Master (< 1600GT Port Operations)
Skipper (< 200GT Port Operations)
Chief Engineer Officer (Port Operations)
Chief Engineer Officer (< 750kW Port Operations) Chief Engineer Officer (< 1500kW Port Operations)
Marine Motorman Grade 2
Marine Motorman Grade 1
Marine Motorman Higher Grade
Endorsement Chief Engineer Officer (<1500kW Port Operations) Endorsement Chief Engineer Officer (Port Operations)
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.
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 3 of 13 FOP-513
C. APPLICATIONS FOR CERTIFICATES OF COMPETENCY MUST BE ACCOMPANIED BY THE FOLLOWING SUPPORTING DOCUMENTATION:
STCW ’78 Deck Officer Certification
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) 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 18 20 18
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.
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 4 of 13 FOP-513
Certification Endorsements
STCW ‘78 Engineer Officer Certification
Chief Engineer Officer Chief Engineer Officer (< 3000 kW) 2nd Engineer Officer 2nd Engineer Officer (< 3000 kW) Engineer Officer Chief Engineer Officer (< 3 000 kW) Chief Engineer Officer (< 750 kW)
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.
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 5 of 13 FOP-513 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
STCW-F’ Deck Officer Certification
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)
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 18 18
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 6 of 13 FOP-513
STCW-F’ Engineer Officer Certification
Chief Engineer (Fishing) Chief Engineer (< 3000 kW Fishing) 2nd Engineer (Fishing)
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 18
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 7 of 13 FOP-513 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.
Non-STCW Deck Officer Certification
Master (Port Operations) Master (< 1600GT Port Operations) Skipper (< 200GT Port Operations)
*
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 20 20 18
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 8 of 13 FOP-513 NOTE:*this only applies to candidates who started their training or sea time after the 23rd of July 2013.
Non-STCW Engineer Officer Certification
Chief Engineer Officer (Port Operations) Chief Engineer Officer (< 750kW Port Operations) Chief Engineer Officer (< 1500kW Port Operations) Marine Motorman Grade 2 Marine Motorman Grade 1 Marine Motorman Higher Grade Endorsement Chief Engineer Officer (<1500kW Port Operations) Endorsement Chief Engineer Officer (Port Operations)
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 18 18 18 18
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 9 of 13 FOP-513
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/
Deck Officer - GT Engineer Officer - Propulsion power (kW) Type of service (unlimited, near- coastal, port operations) Engineers – Steam/ Motor
Rank Dates Actual period Assessed
period
For Official use only.
From To Months Days Months Days
Net qualifying service
Date: ………
Signature of examiner: ………...
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 10 of 13 FOP-513
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-
Coastal)
II/3 Master of a ship of less than 500GT on near-coastal voyages Mate (<500GT Near-
Coastal)
II/3 Officer in charge of a navigational watch on a ship of less than 500GT on near-coastal voyages
Master (<200GT Near- Coastal)
II/3 Master of a ship of less than 200GT on near-coastal voyages Master (<1600GT Port
Operations)
Reg. 24 Master of a ship of less than 1600GT operating within a port operations area
Master (Port Operations) Reg. 25 Master of a ship of any tonnage operating within a port operations area
Skipper (Port Operations) Reg. 19 Master of a ship of less than 200GT operating within a port operations area
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 11 of 13 FOP-513
Endorsements Ref Limitations
Master (Mining Operations)
II/2 Master of a ship of any tonnage engaged in mining operations Chief Mate (Mining
Operations)
II/2 Chief Mate of a ship of any tonnage engaged in mining operations Deck Officer (Mining
Operations)
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 STCW-F
Reference Limitations
Skipper Fishing (≥24m Unlimited)
II/1 Master any ship engaged in fishing on unlimited waters Skipper Fishing
(<24m Unlimited)
II/1 Master of a ship of less than 24 metres engaged in fishing on unlimited waters
Skipper Fishing (≥24m Limited)
II/3 Master any ship engaged in fishing on limited waters Skipper Fishing
(<24m Limited)
II/1 Master of a ship of less than 24 metres engaged in fishing on limited waters
Deck Officer Fishing (<24m)
II/2 Officer in charge of a navigational watch on a ship of less than 24 metres engaged in fishing on unlimited waters
Deck Officer Fishing (≥24m)
II/2 Officer in charge of a navigational watch on any ship engaged in fishing on unlimited waters
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 12 of 13 FOP-513
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 Officer
III/2 None Second
Engineer Officer
III/2 None Chief Engineer
Officer (<3000kW)
III/3 Chief Engineer Officer of a ship of less than 3000kW propulsion power
Second
Engineer Officer (<3000kW)
III/3 Second Engineer Officer of a ship of less than 3000kW propulsion power
Engineer Officer III/1 None Electro-
Technical Officer
III/6 Officer in charge of electronic equipment on board a ship of 1000 Volts or more
STCW-F Engineering Officers
Certificate Ref Limitations
Marine Motorman Grade 2
III/3 Chief Engineer of any vessel <24m <350kW propulsion power Marine Motorman
Grade 2
III/3 Officer in charge of an engineering watch on any vessel <24m
<1000kW propulsion power Marine Motorman
Grade 1
III/3 Chief Engineer of any vessel of less than 1000kW propulsion power on near-coastal or limited waters voyages
Marine Motorman 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 voyages
Marine Motorman Higher Grade
III/3 Officer in charge of an engineering watch on any vessel of less than 3000kW propulsion power on near-coastal or limited waters voyages
Second Engineer Officer (Fishing)
III/3 Officer in charge of an engineering watch on fishing vessels of unlimited propulsion power
Chief Engineer Officer (<3000kW Fishing)
III/3 Chief Engineer Officer of a fishing vessel of less than 3000kW propulsion power
Chief Engineer Officer (Fishing)
III/3 Chief Engineer Officer of a fishing vessel of any propulsion power
Revision No/ Date Title Page Reference 10 – 7.01.15 Application for level 3 assessment; issue Certificate of Competency 13 of 13 FOP-513
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: ……… Name of examiner: ………..
Port: ………. Date: ………