Directorate General of Shipping, EAC Branch

Application for Certificate of Competency as GMDSS Radio Operator

(Refer to Instructions and Guidelines given overleaf for filling up application form)

To The Principal Officer, Mercantile Marine Department, _____________

FRESH / RENEWAL
Name (as per Passport): Passport No.
Colour Surname Given Name
Photograph Nationality
40mm x 30mm
Date of Birth: (DD/MM/YYYY) INDoS No.
PLACE OF BIRTH:
CDC NO Date of issue / Renewal Place of
Issue /
Renewal
Medical Certificate Note: Only photo copy is to be attached Valid till
Issued by:
GOC (GMDSS) Provisional OR Number Valid till
Full term Certificate
Examination Passed Place Date
Last STCW endorsement / COC Number Date of issue
as GMDSS (Applicable only for
renewal) Date of expiry
Certificate of Sea Service in the last 5 years (Minimum one year is required) Note: In absence of sea service or equivalent
service ashore involving Radio communication duties, recent GMDSS course completion certificate will be required.
Vessel particulars Duration Served Sea Remarks
Rank Service
Name Type Port of IMO No. / Served From To Months /
Registry Official No. Days

Details of equivalent shore service performing GMDSS Radio Communication duties, if any:

1. I hereby declare that I comply with the requirements for issuance of Certificate of Competency as
GMDSS Radio Operator under STCW 1978, as amended, and Rule 51 of M.S. (STCW) Rules 2014.
2. I also declare that no enquiry under marine Casualty is pending against me.
Date Place Signature

FOR OFFICIAL USE ONLY

Fees Paid Challan / Dealing
DD No Assistant Sign
I have scrutinized above application in line with applicable guidelines. The eligibility under STCW 78 as amended/
and Rule 51 of M.S. (STCW) Rules, 2014. Candidate is Eligible / Not Eligible for Issuance of
Certificate of Endorsement and the following has been issued to him
COC No. Signature of Duly
Authorized Officer
Date of issue Designation

Date of expiry Issuing Office

Form- WPIF – 7.5-4D-02-01 1st JAN 2016 Rev 1

 Directorate General of Shipping EAC Branch
Checklist for issuance of COC as GMDSS Radio Operator

Following documents are required for issuance of COC as GMDSS Radio Operator
Self attested photo copy of each document must be arranged in the following sequence
NAME: _____________________________ RANK: __________________Date:

SR. DESCRIPTION OF DOCUMENT Fresh Renewal Remarks

NO.
1 Original Challan of Fees paid (Rs. 3000/-)
2 Two more recent color passport size photographs in light
background (Size: 40mm x 30mm) attached with the
application. (to be given in small envelope)
3 Checklist duly completed
4 Application Form in original duly filled up & signed
5 DGS Updated Seafarer’s profile printout – 1st page only
6 Copy of Indian GOC (GMDSS) Certificate with renewal page.
Provisional Certificate copy may be accepted only if the Hard
cover is not yet received.
7 (For FRESH cases) Record of sea service of one year in the
deck department as deck cadet/deck rating/radio officer.
Original letter issued by the owner of the vessel / Agent
regarding sea service with RPSL Number & E-mail Address or
Sea service letter from the company (owners) in case of Indian
Flag Ships.
8 (For RENEWAL of COC) Original previous COC as GMDSS
Radio operator or STCW endorsement on GMDSS
9 (For RENEWAL of COC) Record of sea service of one year in
the last five years performing the duties of Radio
communication or equivalent service ashore or the recent
GMDSS course completion certificate
10 Copy of CDC (record of sea service in the last five years)
OR Original experience certificate from the employer for
services performed ashore involving Radio communication
duties and copy of CDC first page only.
11 Copy of Passport (First & last page)
12 Copy of valid Medical Fitness Certificate (Copy of company
medical certificate obtained prior joining last ship will also be
accepted)
Note: 1) All original documents will be verified by the MMD either at the time of application or at the time of issuance
of COC
2) Application is liable for rejection if it is not filled up completely and if the necessary documents listed above
are not enclosed.

Name of Applicant: Signature: Confirmation by

Dealing Assistant:

ACCEPTED /
NOT ACCEPTED*

Form- WPIF – 7.5-4D-02-01APP 1st JAN 2016 Rev 1