Published on Australian Maritime Safety Authority (https://www.amsa.gov.au)
This form can be used as evidence of sea service accrual as part of an application for a certificate of competency issued under National Law.
When to complete this form
Read about qualifying sea service before completing this form.
You should complete this form if you are recording sea service before applying:
Read about qualifying sea service before completing this form.
>You can fill in this form online before downloading it as a PDF document, or print a blank form.
You should use the key at the bottom to help you complete this form accurately.
You will need to complete a new form for each vessel and role where you completed sea service.
For example: if you were on a vessel that operated for 5 days as the first mate (undertaking a voyage in a role as in charge of a navigational watch and then 15 days as the engineer only and not as a mate), you need to fill out two forms for this sea service.
You need to make sure you write the duties you completed on the form and that they are relevant to the certificate you are applying for.
For example: if you are performing both deck and engineering duties and you want to use this sea service for both types of certificates, use the ‘DE: Deck and engineering’ option. If you are performing duties as engineer and do not want to use this sea service for a deck certificate, use one of the engineer options.
You need to make sure that your supervisor completes the supervisor name, contact number and signature sections for each form. We may contact your supervisor to check that you have recorded your sea service accurately.
You must write your name, sign and date each form.
We can only make decisions about your application based on the information you have provided. Incorrect or missing information will delay the issue of your certificate.
For all certificate of competency application types, you should submit the form with your certificate of competency application form 426.
Specific requirements for your certificate of competency can be found on the page for that certificate.
Submitting this form with your certificate of competency application means that you are declaring that to the best of your knowledge the information contained on the form is true and correct.