CHECK LIST FOR FILLING THE APPLICATION FOR

RE-VALIQATION OF COC

Three applications are given against which one for draft and two for final submission to MMD.

up the application form in CAPITALS, no NOT OVERWRITE ENTRIES Data is within the tables given.

  1. NAME: Name on the application to be filled as per COC in case of HARD COVER (Booklet) but the same varies for the candidates holding SOFT COVER (A4 Sheet).
  2. Details of Previous Certificate: COC Grade & No with the validity which is extension period of the

3. D.O.B: Date of Birth. Place of Birth, INDOS No. CDC No. Grade & passport No. to be entered in the blank Space provided.

a) Additional Certificate:Medical Fitness Certificate (MFC) Number to be filled with the date of issue and name of the DG approved Doctor who has issued the certificate.MFC to be produced in ILO format from a DG approved Doctor.

b) Revalidation Course Certificate:REO certificate No which is being undergone at SSMA.

4. Sea Service: For the last 5 years as per the CDC to mentioned beginning with the latest entry in the first line and in case of insufficient space in the application continuity in the additional annexure sheets.

5.Shore Service:Applicable to candidates from Shore service with minimum requirement being 3 years in last 5 years. If applicable to be filled as Letter enclosed and in casenot applicable

6.Has to be filled as Not applicableas it is related to accidents and enquiry on board the ship

7. Has to be filled asNot applicable related to accidents and enquiry on board the ship

8. has to be filled as Not applicableas it is related to accidents and enquiry on board the ship

9. Rs.5000 to be submitted by cash only inorder to Organize consolidated DEMAND DRAFT against the total number of applications collected from Revalidation course candidate’s inorder to process to MMD, Chennai.

10. a) 5 Photographs (35 X35 mm size color) with 2 affixed on the application and 3 in a transparent pouch stapled on the 1st application.

b) Details of Upgradation: Applicable candidates undergone Upgradation Course from 78 to 95 convention.

Declaration:

Date: Signature:

Note:

1. Specimen Signatures not to exceed the box provided under OFFICE USE

2. Contact details and address to furnished on the reverse side of application with active landline and mobile number as well as E-mail id which arc mandatory.

The following documents (2 COPIES EACH OF THE FOLLOWING) are to be submitted:

a)Application form duly filled as per the checklist.

b)INDOS certificate(In A4 or half of A4 size)

c)COC (Relevant Pages)

d)Up-gradation course certificate (if applicable)- 78 to 95 convention

e)Up-gradation course certificate - current course that has been undergone 95 to 2010 convention

f) Sea Service Letter from the company for atleast 1 year from the last 5 years -Original & Copy 1each

g)Watch keeping certificate (other than of CE)

h)Relevant pages from CDC for the last S years

i)Passport (1st& Last page)

j)Medical certificate— Original & Copy I each

k)Following STCW 95 certificate copies (2 each):

  1. Advance Fire Fighting course
  2. PSCRB
  3. Medical First Aid
  4. PSSR

l)Following STCW 2010 convention certificate copies (2 each):

  1. Refresher AFF & FPFF certificate
  2. Refresher PSCRB certificate
  3. STSDSDor SSO Course

m)Cash of Rs.S000/- towards application fees to MMD

n)Seafarer's Registration duly signed on the last page above signature of the candidate

o)Two independent applications tagged along with complete set of documents in plastic folder to be submitted to concerned personnel dealing with submission to MMD.

All copies of the above certificates (excluding original ie. Company service letter and Medical Fitness certificate) are to be self attested.

Duly filled in Application along with the above relevant documents received on or before Fridays prior 1400 hrs will be submitted to MMD subsequent Mondays and applications received thereafter will be processed during Wednesdays.