Doc. No.

: DMA – 2
Page No.: Error! Quality System Danish Maritime
Unknown switch
Argument of 2 Procedure Authority
Ministry of Trade and
Industry
Prep.: HHI
RESP.: AN ASSESSMENT OF OFFICERS MARITIME EDUCATION DIVISION

Appendix I.

QUESTIONNAIRE
Officer’s Details
First Name(s) Surname

Nationality Date of Birth

Details of Certificate of Competency

Name of country issuing Certificate Certificate: Specify STCW-Regulation and Capacity

Certificate Number Last STCW revalidation date (if any)

Date of Issue Valid Until

Details of Experience
Describe what maritime education and training (MET) you have completed to obtain your first certificate of competency as an of

Maritime School Attended Maritime Course & Year Graduated Duration of Course

Name, Flag & Type of Training Ship Agency & Shipping Company Capacity & Duration of Sea Service

Training Institution attended to obtain first

Training
COC Certificate
as an officer
& Year Obtained Duration of Training

Describe your previous practical experience as an Officer.

(Please answer in an essay form)
 Doc. No.: DMA – 2
Page No.: Error! Quality System Danish Maritime
Unknown switch
Argument of 2 Procedure Authority
Ministry of Trade and
Industry
Prep.: HHI
RESP.: AN ASSESSMENT OF OFFICERS MARITIME EDUCATION DIVISION

Describe your present working situation including latest employment at sea.

(Please answer in an essay form)

Describe technically the specific types of ships where you have been employed (amount of details to approximately suit
the space provided below). Information on the last three (3) ships boarded.
Name & Flag GT or KW & Type Agency & Company Capacity & Period of
Sea Service

Have you previously been employed in Danish ships?

(If yes, please state name of company and types of ships)

For applicants for recognition certificate for service at management level (chief mate, chief
engine officer, second engineer officer): Have you read the publication “Extracts of Danish
Maritime Legislation”
YES NO

. .
Place & Date Signature