APPLICATION FOR REVALIDATION OF CERTIFICATE OF COMPETENCY

Name: Date of Birth: Place of Birth:

Passport No. CDC No. INDoS No.:
Address:
Phone No. Mobile Email Id.:

COC Grade: No.: Date of Issue:

Additional Certificates Number Date of Issue Issuing Authority

Medical Fitness Certificate
Revalidation Course

GMDSS GOC
STCW Endorsement on
GMDSS - GOC

SEA SERVICE FOR THE LAST FIVE YEARS (Attach copy CDC and service record duly authenticated by employer):

Name of ship GT Trade Type of Capacity From To Period

Ship MM DD

Details of service performed other than onboard ships during ships last 5 years giving period of service, designation, nature
of duties, name, address & contact of employer(attached employer Certificate)

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Did any of the ships mentioned in para 4 suffer any casualties during your service on board? If so, give details of date. Time
And nature of casualty.

_____________________________________________________________________________________________________________

Did you undergo any inquiry by any Government or other Authorities in connection with your service on board ships mentioned
in para 4? If so. Give details of date, place, name of Authority and nature of inquiry.
_____________________________________________________________________________________________________________

Fees Rs. 2.500 for Revalidation of Certificate of Competency has been deposited (receipt attached)

Three copies of 35 mmx 35 mm size colour photographs.

I hereby declare that the information given above is correct and true to the best of my knowledge and belief.

Date : Signature of Applicant.

Note: Any person who makes any false representation or knowingly givens an false information is liable for punishment of cheating under
section 182 and 420 of Indian Penal Code and revalidation certificate issues on such information will be withdrawn forthwith.

Specimen
Signatures.
 (FOR OFFICE USE ONLY)

The Eligibility of the candidate for issuance of revalidation endorsement was scrutinized in accordance with the guidelines and found to be in
order.

* The certificate of competency revalidate until

Date:_____________________________ EXAMINER OF MASTERS & MATES

MERCANTILE MARINE DEPARTMENT
MUMBAI / KOLKATA / CHENNAI

* Copy of endorsement annex If shall be forwarded to chief examiner of master and mates within 7 days from the date of issuance

__________________________________________________________________________________________________________________________

Requirement for Revalidation of Masters & Deck Officers of Foreign Grade

1. Certificate of Competency issued under STCW95

2. Medical fitness certificate as per M.S. (Medical Examination) Rules, 2000.

3. 10 days Revalidation course certificate for Master & Deck Officers in prescribed format as per M.S. Notice No.
13 of 2003

4. Approved sea going service, performing functions appropriate to the certificate held, for a period of at least one
Year in total during the preceding five years; OR

Having performed functions considered to be equivalent to the seagoing service (e.g. officers working in marine
Related jobs, e.g. maritime surveyors, lecturers, superintendents, pilots, etc, OR

Having completed approved seagoing service, performing functions appropriate to the certificate held, for a
Period of not less than three months in a supernumerary capacity, OR in a lower officer rank than that for which
the certificate held in valid immediately prior to taking up the rank for which it is valid, OR

Having attended approved courses as per M.S. Notice No. 10 of 2004 for the respective grade as specified.

5. Payment of fees of Rs.2500/-as required under Rule 50 of Merchant Shipping (STCW) Rules 1998.
6. Valid GMDSS Endorsement?
7. CDC
8. Passport
9. Three copies of Colour photographs of 35 mm x 35 mm
10. Refresh & updating course
11. Indos No