Directorate General of Shipping EAC Branch

CHECK LIST FOR NCV CLASS IV

NAME OF MERCANTILE MARINE DEPARTMENT

Following Documents Are Required For NCV Class IV Written and Oral Examination and Assess;nent
Photo Copy Of Each Documents must be Self Attested and be Anan.qed In The Following Seouence
Name Of The Candidate: Date:

ASSESSMENT FOR WRITTEN EXAMINATION

NAME OF DOCUMENTS
of CDC including relevant pages of sea service.
ofPassport (1" and last

Sighting Original of Previous Certificates: i.e. SGED / FVED / ERR

Watch keeping Certificate / ITI / Diploma in Mechanical Engineering or
Electrical or any other certificate.
ofPre Sea course.
Original Sea Service letter issued by the Owner of the Vessel / RPSL
(Addressed to PO, MMD )
Copy of Sea Service Testimonials. Indicating Article Time
of Article of Agreement (Only for Indian Flas vessels)/Form 3A
Sea Service Extract ( Only Navy Candidate
Online Printout of Seafarers Profile (U
Copy of Valid Medical Fitness Certificate (DGS A
DOCUM BE SHOWN - PLEASE FILL IN THE CERTIFICATE
Certificate No Name of the lnstitute
Orieinal of STCW Course as follows:-
PST Valid within 5 years or Refresher
FPFF Valid within 5 vears or Refresher
Elementary First Aid valid within last 5 year

Evidence of Assessment Fees as applicable Paid

SIGNATURE OF VERIFYING DA APPROVING AUTHORITY

ORAL ASSESSMENT & BOOKING

Sr. No. NAME OF DOCUMENTS YES/NO REMARKS
l5 Copy of Result of Written Examination.
l6 Copy of Sea Service Testimonials. Indicating Article Time
Copy of Article of Agreement (Only for Indian Flag vessels)/Iorm 3A
DOCUMENTS TO BE SHOWN AND TAKEN AWAY - PLEASE FILL IN THE CERTIFICATE No oR wnTTE N,I
DETAILS Cert. No. Name of Institute
t7 Sighting Original of STCW Course as follows:-
PSCRB OR Refresher
il AFF 2010 OR Refresher
ii i) Medical First Aid valid within last 5 years
iv) SSO or STSDSD
PSSR Updated to 2010
vi) TAR BOOK
a^ Fees: Oral Assessment & Examination as applicable
Signature of Verifoing DA APPROVING AUTHORITY

WPIF-7.5- 24-03-NCV-CLry OIST JAN 20I5 REV OO