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 ____________________