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Directorate General of Shipping, EAC Branch

Documents to be submitted for Assessment of Eligibility for Writtens/Orals


Name of the MMD: Checklist Rev.2 dtd 03.03.2016

Candidate Name: ___________________________


INDOS No. ________________________ DOB: _______________
Candidate Mobile No. ______________________ Email id: _____________________
Grade: Master / ASM (F.G)

Enclosed Original
photocopy verified by
SNO Particulars YES/ NO / the Principal
NA Yes/No/NA
For Written Assessment
1 Assessment online payment receipt printout copy
Form-29 (previously called as Form-15) - Print out of application submitted online
2 using e-Samudra (Colour Photograph in light back ground )
Sea service letters from the Indian ship owners / RPSL agencies - addressed to the
3 Principal Officer, MMD (original)
4 Article of agreement copies for service in Indian ships*
5 Form -3A copy in case of service in foreign flag ships copy*
6 Bridge WKG duties certificate issued by Master copy
7 CDC relevant pages copies
8 Valid Medical certificate and eye sight test report (Copy only)
9 Passport - First and last page copy only.
10 Chief Mate F.G COC (issued by DGS) copy
11 ASM (FG) course completion certificate issued by DGS approved institute(copy)

For Orals Assessment


12 Seat Booking online payment receipt printout copy
13 Ship Security Officer course certificate copy
12 ECDIS course certificate copy
15 Ship Manouvering Simulator (SMS) course copy

For making an application for COC


16 Certificate of Competency as GMDSS Radio Operator
Refresher training in PSCRB and PST (Required only if the initial course certificates are
17 more than five years old)
Refresher training in AFFF and FPFF (Required only if the initial course certificates are
18 more than five years old)
Refresher and updating training course for deck officers - management level - 11 days
(Applicable for all the candidates obtained their first mate FG COC under the STCW
19 1995 syllabus)

*Note: If sea service is shown in the Master Checker then AOA and Form 3A will not be required

Candidate's Signature ____________________


Directorate General of Shipping, EAC Branch
Documents to be submitted for Assessment of Eligibility for Writtens/Orals
Name of the MMD:
Candidate Name: ___________________________ Checklist Rev.2 dtd 03.03.2016

INDOS No. ________________________ DOB: _______________


Candidate Mobile No. ______________________ Email id: _____________________
Grade: Chief Mate (F.G)

Enclosed Original
photocopy verified by
SNO Particulars YES/ NO / the Principal
NA Yes/No/NA
For Written Assessment (Phase I)
1 Assessment online payment receipt printout copy
Form-29 (previously called as Form-15) - Print out of application submitted online using e-
2 Samudra (Colour Photograph size: in light blue back ground )
3 Sea service letters from the RPSL/Owner company (original)
4 Article of agreement copies for service in Indian ships*
5 Form -3A copy in case of service in foreign flag ships copy*
6 Valid Medical certificate and eye sight test report (Copy only)
7 Bridge WKG duties certificate issued by Master (copy)
8 CDC relevant pages copies
9 Passport first and last page only copy
10 2nd Mate F.G COC (issued by DGS) copy
11 Phase I course completion certificate issued by DGS approved institute (copy)

For Written Assessment (Phase II)


12 Assessment online payment receipt printout copy

13 Form-29 (previously called as Form-15) - Print out of application submitted online using e-
Samudra (Colour Photograph size: in light blue back ground )
14 Sea service letters from the RPSL/Owner company (original)
15 Article of agreement copies for service in Indian ships*
16 Form -3A copy in case of service in foreign flag ships copy*
17 Bridge WKG duties certificate issued by Master (copy)
18 CDC relevant pages copies
19 Passport relevant pages copies
20 Phase II course completion certificate issued by DGS approved institute (copy)

For Orals Assessment


21 Seat Booking online payment receipt printout copy
22 Radar & Navigation Simulator (RANSCO) course copy
23 DGS approved ECDIS course copy
24 Ship Security Officer course (SSO) copy
25 Ship Masters Medicare (Medicare) course copy
*Note: If the sea service is shown in the Master checker then the copy of AOA and Form 3A not required

Candidate's Signature ____________________


Directorate General of Shipping, EAC Branch
Documents to be submitted for Assessment of Eligibility for Writtens/Orals
Name of the MMD: Checklist Rev.2 dtd 03.03.2016

Candidate Name: ___________________________


INDOS No. ________________________ DOB: _______________
Candidate Mobile No. ______________________ Email id: _____________________
Grade: Second Mate (F.G)

Enclosed Original
photocopy verified by
SNO Particulars YES/ NO / the Principal
NA Yes/No/NA
For Written Assessment
1 Assessment online payment receipt printout copy
Form-29 (previously called as Form-15) - Print out of application submitted online using
2 e-Samudra (Colour Photograph in light back ground )

3 Sea service letters from the Indian ship owners / RPSL agencies - addressed to the
Principal Officer, MMD (original)
4 Article of agreement copies for service in Indian ships
5 Form -3A copy in case of service in foreign flag ships copy
6 SSTP completion certificate, in case of DNS candidates
7 Valid Medical certificate and eye sight test report (Copy only)
Essential pages of Cadets Record Book for DNS and B.Sc candidates. (Original CRB will be
8 verified during the oral examination)
9 Record of 6 M bridge WKG duties documented in approved record book copies
10 DGS approved Pre-sea course completion certificate copy
11 HSC/XIIth STD/Degree Mark sheet copy
12 Personal Survival Techniques course copy
13 Elementary First Aid course copy
14 Fire Prevention and Fire Fighting course copy
15 Personal Safety and Social Responsibility course copy
16 CDC relevant pages copies
17 Passport first and last page and relevant pages copy
18 Indos copy
Second Mate (FG) 4 months functions course completion certificate with the result of
19 Internal Assessment copy (NA for 3 or 4 year B.Sc NS/NT/BE -Marine candidates)

Additionally for the candidates from the Rating Stream:


20 Letter of eligibility issued by the MMD copy
21 Foundation course pass certificate from Institute copy
22 NWKO-NCV Course completion certificate from Institute copy
23 NWKO-NCV pass certificate from Institute copy

For Orals Assessment


24 Seat Booking online payment receipt printout copy
25 Radar Observer and ARPA Simulator (ROC-ARPA) course copy
26 Proficiency in survival craft rescue boats courses (PSC-RB) course copy
27 Advanced Fire Fighting (AFF) course copy
28 Medical First Aid (MFA) course copy
29 Electronic Chart Display and Information System (ECDIS) course copy
30 Global Maritime Distress and Safety System (GMDSS) course copy
31 Designated Security Duties (STSDSD) or Ship Security Officer (SSO) course copy
32 Degree certificate for B.Sc NS /MS/NT/BE Marine (Provisional or Final degree) copy

Candidate's Signature ____________________