APPLICATION FOR EXAMINATION (LEVEL 3 … 11 - FOP-513 Rev 10... · Marine Motorman Grade 2 Marine ... Communication 1 certificate ... II/2 Master of a ship of less than 3000GT on

FOP-513

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 ………………………………………………….

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 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.

FOP-513



C. APPLICATIONS FOR CERTIFICATES OF COMPETENCY MUST BE ACCOMPANIED BY THE FOLLOWING SUPPORTING DOCUMENTATION:

STCW ’78 Deck Officer Certification

Ma

ste

r

Ma

ste

r (

< 2

00

GT

)

Ma

ste

r (<

500

GT

)

Ma

ste

r (<

300

0G

T)

Ch

ief

Ma

te

Ch

ief

Ma

te

(< 3

000

GT

)

De

ck

Off

ice

r

Ma

ste

r (

< 2

00

GT

ne

ar

co

as

tal)

Ma

ste

r (

< 5

00

GT

ne

ar

co

as

tal)

Ma

te

(< 5

00

GT

)

Ma

te

(<

50

0G

T

ne

ar

co

as

tal)

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.

FOP-513



Certification Endorsements

STCW ‘78 Engineer Officer Certification

Ch

ief

En

gin

ee

r

Off

ice

r

Ch

ief

En

gin

ee

r

Off

ice

r (<

300

0 k

W)

2n

d E

ng

inee

r O

ffic

er

2n

d E

ng

inee

r O

ffic

er

(< 3

000

kW

)

En

gin

ee

r O

ffic

er

Ch

ief

En

gin

ee

r

Off

ice

r (<

3 0

00

kW

)

Ch

ief

En

gin

ee

r

Off

ice

r (

< 7

50

kW

)

Proof of identity

3 x colour passport-size photographs

Medical certificate (SAMSA-approved medical practitioner)


Proof of qualifying service (Discharge Book)


Practical workshop training certificate from an accredited institution

Watch-keeping certificate/s


Pre-sea/basic training certificates


Medical first-aid 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.

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

De

ck

Off

ice

r F

ish

ing

(< 2

4m

)

De

ck

Off

ice

r F

ish

ing

(≥ 2

4m

)

Sk

ipp

er

Fis

hin

g

(< 2

4m

lim

ite

d w

ate

rs)

Sk

ipp

er

Fis

hin

g (

< 2

4m

un

lim

ited

wa

ters

)

Sk

ipp

er

Fis

hin

g

(≥ 2

4m

lim

ite

d w

ate

rs)

Sk

ipp

er

Fis

hin

g (

≥ 2

4m

un

lim

ited

wa

ters

)

ID document or passport



SAMSA Eye test certificate

Proof of sea service

Pre-Sea Training (Safety Familiarization Training)

Previous certificate of competency



Medical first-aid certificate

Medical care certificate

Proficiency in Survival Craft and Rescue Boats

Personal survival techniques

Fishing safety #



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 $


Minimum age 18 18

FOP-513



STCW-F’ Engineer Officer Certification

Ch

ief

En

gin

ee

r

(Fis

hin

g)

Ch

ief

En

gin

ee

r (<

30

00

kW

Fis

hin

g)

2n

d E

ng

inee

r (F

ish

ing

)








Trainee Watch-keeping Certificate

Pre-sea Safety Awareness Training


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

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

Ma

ste

r (P

ort

Op

era

tio

ns

)

Ma

ste

r (<

160

0G

T P

ort

Op

era

tio

ns

)

Sk

ipp

er

(< 2

00

GT

Po

rt

Op

era

tio

ns

)*

ID book or passport




Proof of qualifying service


Trainee watch-keeping certificate/s

Watch-keeping certificate/s

Testimonial from Company Training Officer


Medical first-aid 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


Minimum age 20 20 18

FOP-513



NOTE: *this only applies to candidates who started their training or sea time after the 23

rd of July 2013.

Non-STCW Engineer Officer Certification

Ch

ief

En

gin

ee

r O

ffic

er

(Po

rt O

pe

rati

on

s)

Ch

ief

En

gin

ee

r O

ffic

er

(< 7

50k

W

Po

rt

Op

era

tio

ns

)

Ch

ief

En

gin

ee

r O

ffic

er

(< 1

500

kW

P

ort

Op

era

tio

ns

)

Ma

rin

e M

oto

rma

n

Gra

de

2

Ma

rin

e M

oto

rma

n

Gra

de

1

Ma

rin

e M

oto

rma

n

Hig

he

r G

rad

e

En

do

rse

men

t C

hie

f

En

gin

ee

r O

ffic

er

(<1

50

0k

W P

ort

Op

era

tio

ns

)

En

do

rse

men

t C

hie

f

En

gin

ee

r O

ffic

er

(Po

rt

Op

era

tio

ns

)







Trainee Watch-keeping Certificate * * *


* * *

Certificate of results (from an accredited institution) * * *

Approved Training Record Book * * *

Medical first-aid course certificate



Personal survival techniques


Minimum age 18 18 18 18

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 O

ffic

er

- G

T

En

gin

eer

Off

icer

- P

rop

uls

ion

po

wer

(kW

)

Ty

pe o

f serv

ice

(u

nlim

ited

, n

ear-

co

asta

l, p

ort

op

era

tio

ns

)

En

gin

eers

– S

team

/ M

oto

r

Rank Dates Actual period Assessed period

For Official use only.

From To Months Days Months Days

Net qualifying service

Date: ……………………………… Signature of examiner: …………………………...

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


Mate (<500GT) II/3 Officer in charge of a navigational watch on a ship of less than 500GT 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

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


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


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

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


III/3 Chief Engineer of any vessel <24m <350kW propulsion power


III/3 Officer in charge of an engineering watch on any vessel <24m <1000kW propulsion power


III/3 Chief Engineer of any vessel of less than 1000kW propulsion power on near-coastal or limited waters voyages


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

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: …………………………………

Documents

APPLICATION FOR EXAMINATION (LEVEL 3 … 11 - FOP-513 Rev 10... · Marine Motorman Grade 2 Marine ... Communication 1 certificate ... II/2 Master of a ship of less than 3000GT on