Overview
Use this form as evidence of sea service when you apply for a near coastal certificate of competency.
This form cannot be used to apply for an STCW certificate.
How to complete this form
You can either:
- download a blank copy of this form, or
- fill in the form online and download it as a PDF.
Before you start
- Check the type and amount of sea service required for the certificate you want.
- Read about how to calculate and record your sea service.
On each form you can only list one vessel, one mode of operation, and one type of duty.
Use multiple forms as needed.
To complete this form:
- Fill in your details.
- Add the operational and vessel details.
- Sign and date the form.
- Have your supervisor sign and date the form. The signature field can be electronically or physically signed. It cannot be typed.
Note: anything crossed out or whited out must be signed and dated by your supervisor.
Access the form
Last updated:
6 February 2026