Application for Issuance of Certificate (Endorsement) for Service on Tankers

(Refer to instructions and Guidelines given overleaf for filling up application form)
To,
The Principal Officer, Mercantile Marine Department, Chennai.

SUB: Application for Issuance of Certificate (Endorsement) for Service on Tankers.

Particulars of Candidate:
First

Middle

Last

1.Name: (in Block Letters)

2. Date of Birth:
Date of
issue:

3)(a) C.D.C.: Number

3)(b) INDos: Number

DD

MM

YY

Place of Issue:

Date of
issue:

4) Certificate of Competency / Service

Grade :

No.:

5) Medical Certificate: [ Format as per ILO Convention ( Photocopy to be attached)]

6) Modular Courses Done:(Photocopy to be attached)
Yes

No

a. Fire Prevention and Fire Fighting(Basic)

b.Advanced Fire Fighting:
C.Oil / Chemical / Gas * Tanker Familiarisation / Safety * Course:
d. Specialised Training Programme on Oil / Chemical / Liquid Gas Tankers:
e. Liquid Cargo Handling Simulator Course (2 1/2 Days):
f.Liquid Cargo Handling Simulator Course (5 days):
*Delete as appropriate
7) Record of Sea Service:

(On type of Tankers for which endorsement in sought)

Rank

Duration Served
Total Time
Served

Vessels Particulars
Name

Type

Port of Registry

Served

From

8) Issuance of Certificate (Endorsement) of service on Tankers requested as follows:

Type of Tanker
Oil / Chemical / Liguid Gas* Tanker

Certificate of
Competency
held

To

Level#
Level 1 / Level

2 **

9) Previous Endorsement if any:

Number :

Date of Issue:

Place of Issue:

*Delete as appropriate
**Level 1 = Qualified to be assigned specific duties and responsibilities related to cargo equipment
*** Level 2 = Qualified to hold immediate responsibility for loading, discharging and care in transit or handling of cargo.
I hereby declare that the particulars given above are correct and true to the best of my knowledge and belief. I have read the instructions given overleaf.
Date:
Place:
Signature of applicant: ..
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __

(FOR OFFICIAL USE)

Receipt

Office

No.:
Date
Assistant ..:
I have scrutinized above application in line with applicable guidelines. Candidate is eligible / not eligible for Certificate (Endorsement) for service on
Tankers as requested and may be issued.
Endorsement No.:
Signature..
Dated
Name of Officer
In Capacity ofLevel1 / Level 2
Designation..
Type of Tanker Oil / Chemical / Liquefied Gas

Fees Paid Rs.:

Instructions and Guidelines

(Instructions for filling the Application Form for DC Endorsement)
Note:
1.

Application should be accompanied by original certificates and photocopies of following:

(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)

C.D.C / INDos No. Cert. / Passport

Certificate of Competency (For Officers)
Medical certificate
Fire prevention and Fire Fighting
Advance Fire Fighting
Oil / Chemical / Gas Tanker Familiarization Course
Speciallised training Programme on Oil / Chemical / Liquid Gas Tankers
Liquid Cargo Handling Simulator Course 2 days (Operational Level)
Liquid Cargo Handling Simulator Course 5 days (Management Level)
Previous Dangerous Cargo Endoresement.

2.

Applicant should apply and collect certificate in person.

3.

Application for Certificate (Endorsement) for service on Tankers for each type of Tankers should be applied separately.

4.

Application should be accompanied by original Certificates.

5.

Medical certificate submitted should be issued within last 6 months prior to application date.

6.

Modular courses required in 6 are as per following regulations:

Training

Level 1
Basic
STCW 95
Reg. V/1
Para 1

Officers
Ratings
Operational Level
Support Level
-Appropriate certificate of Competency
W/K Certificate
-Advanced Fire Fighting Course
-Fire Prevention and Fire Fighting
(STCW Code A-VI/3)
(STCW Code A-VI/1-2)
-Tanker Familiarization Course (Oil / Chemical /Liquified Gas Tanker ) AND
- Liquid Cargo handling simulator Course of 2-1/2 days (For Deck Officers on Tankers Only)
OR
- 3 months supervised shipboard service (Oil / Chemical / Liquified Gas Tanker

Level 2
Advanced
STCW 95
Reg. V/1
Para 2

Revalidation of Tanker
Endorsement STCW
95 Reg. 1/11 para. 1

Management Level
-Appropriate certificate of Competency
-Advanced Fire Fighting Course ( STCW Code A-VI/3)
-Specialised Training Programme on:
-Oil Tanker Operations OR Chemical Tanker Operations OR
-Liquified Gas Tanker Operation
-3 months experience appropriate to duties on the type of tanker
-Advanced liquid Cargo handling simulator Course of 5 days ( For Deck Officers on Tankers Only)

-At least 3 months experience during last five years on appropriate type of tanker
OR
Undertake appropriate refresher training

7.

Record of Sea-Service
7(a) Record of Sea-Service required is to be filled starting from latest first.
7(b) For Foreign flag Vessels the Sea-Service has to be duly verified by the local representative (in india)
of the Owner/ Manager on letter head. (FOSMA/MASSA Member) OR Documents to be endorsed by Indian Consulate Abroad or Appropriate Consulate in India.

8. Candidates should ensure that Form is correctly filled up and all required documents are attached, otherwise candidate will be declared inelligible for
Certification.
9. Candidates are reminded that Fees once paid cannot be re-imbursed or transferred, hence ensure prior payment that he is meeting the requirements applicable for
DC Endorsement.
10.

Two recent passport size colour photographs are to be submitted along with the application form.

11.

Payment of fees, to be made by Bank Demand Draft in favour of P.O. MMD Chennai.

Fees payable as follows:

DC Endorsement as per 1995 convention: RS.1,000/12. Any person who makes a false representation or knowingly gives a false information is liable for
420 of the Indian Penal Code.

punishment for cheating under Sections 182 and