MSF 4275 -----------------------------------------------------------------------------------------------------------------------------------------APPLICATION FOR AN ORAL EXAMINATION LEADING TO THE ISSUE OF A CERTIFICATE OF COMPETENCY (STCW) FOR Engineer Officers in the Merchant Navy ------------------------------------------------------------------------------------------------------------------------------------------ 1. PERSONAL DETAILS Title: MR Nationality: INDIAN National Identity Number: PUT YOUR PASSPORT NUMBER Full Home Address: MENTION THE ADDRESS WHERE YOU ARE STAYING Address for return of documents: IF COURIER SERVICE IN THE AREA WHERE YOU ARE STAYING IS NOT RELIABLE, PLEASE PUT AN ALTERNATIVE ADDRESS HERE OF SOME BIG CITY SO THAT YOUR COURIER DOES NOT GET SENT BACK TO UK BECAUSE OF NON DELIVERY. IF THE COURIER SERVICE IN YOUR HOME ADDRESS IS GOOD, LEAVE THIS SECTION BLANK. 2. CERTIFICATE APPLIED FOR Second Engineer III/2 Unlimited None Motor \/ Leave the SDS Number blank on the bottom right hand corner of the page. 3. SEA SERVICE Vessel Name: Only vessels after Class 4 CoC have to be put. Ships name can be written latest to earliest from top to bottom or vice versa. IMO Number: Check the IMO number on the ship stamp and put it on the form. If the IMO number is missing, you can put the Official Number of the ship as well. Flag: Indian, Panama, Liberian, Singapore, etc. Reg. Power (KW): Put the Maine Engine power S/M: Motor Type: Container / Bulk Carrier / Tanker / Ro Ro 4. CHECKLIST Put your Class 4 / Class 5 / MEC3 CoC Certificate No., Capacity and Country of Issue in this section. 4A FOR ALL APPLICANTS Attested copy of Passport (\/) CDC and Sea Service Testimonials (\/) Two Passport Size Photographs (\/) Valid Medical Fitness Certificate (\/) Please note that the Medical Fitness Certificate has to be in the ILO147 format from a DG Shipping approved doctor. You may contact your shipping company doctor for the same. If your earlier medical fitness certificate (that you used for joining your last ship) is still valid for the next 6 months, then you do not need to get a new medical fitness certificate. 2 photographs size 40 mm x 50 mm required with white background. Behind one photograph, please write your name in CAPITAL LETTERS and your DATE OF BIRTH. Behind the other photograph, please write your name in CAPITAL LETTERS. Then the person who has countersigned in section 6 of the NOE form needs to write “ I CERTIFY THAT THIS IS A TRUE LIKENESS” and sign behind the photograph. 4B APPLICATIONS FOR A FIRST UK CERTIFICATE OF COMPETENCY Leave this section blank. It is for applicants who are applying for a Class 4 (EOOW) CoC. 4C APPLICATION FOR A SUBSEQUENT CERTIFICATE MNTB / MCA Approved UK academic qualifications …………… (\/) Put a tick mark if you hold a BE Marine / Mechanical certificate and have obtained a NARIC LoC to be eligible for exemptions. 5. YOUR SIGNATURE AND DECLARATION Put your signature in the rectangular block. Make sure that the signature does not go outside of the box as this signature will be embossed on your CoC. Put the date on which you have signed on the form. In the rectangular block mentioned “for office use only”, do not write anything and do not paste your photograph over there. 6. COUNTER SIGNATURE Somebody who knows you in a professional relationship but is not your friend or relative needs to fill up and sign in Section 6 of the form. This person also needs to sign behind one of the photographs. This person could be a Captain, Chief Engineer, Superintendent, Doctor, Lawyer, Police Officer, School / College teacher, etc. 7. PAYMENT Click on the payment option Cheque / Bankers Draft (\/) If you are making a payment by Credit Card, please fill the card details in the NOE form. You will also need to sign below on the form. If the payment is made by a Demand Draft, do not sign on the form. Payment for the NOE is 201 GBP and the DD is to be made in favour of “THE MARITIME AND COASTGUARD AGENCY”.