Marine Order 503 includes a power that permits AMSA to approve alternate forms of survey. You can use this form to make an application for an alternate survey process under Marine Order 503 (Certificates of survey – national law).

Application details

Title (Mr, Mrs, Dr, etc)	Surname	Given names

Phone	Mobile	Email

Vessel Name	UVI	Current service categories

Has the vessel held a certificate of survey?	Yes No

Has the vessel operated under a certificate of operation?	Yes No

Are you seeking an alternate form of initial survey?	Yes No

Are you seeking an alternate form of periodic/renewal survey?	Yes No

Application type

New vessel	Transitional vessel	Existing vessel

Details for vessels undergoing a change – proceed to section D if no changes are occurring

Details of the change(s) that has or will occur (if applicable)

Marine Order 503 – Schedule 1 – vessel change(s)	Required survey type
1 New or upgraded service cat	2 Geo restriction removal	6(b) Large engine increase	7 Change to structure or watertight integrity	X Out of survey for more than 2 years	Full initial
3 DG carriage commenced	4 Overnight ops with Accom commenced	5 Increased persons or pax	6(a) New Berths	6(e) Increased windage	6(f) Installed deck load / ballast	Initial to extent of change + renewal
Other change(s) ― Specify 503 Schedule 1 reference number(s):	Renewal only

Reason(s) you believe the required survey type shown in the table above is not appropriate

Application background

A records request has been made to the jurisdiction that first issued the vessels certificate, and all available records have been obtained and will be attached as supporting documents (Section E.):	Yes No
A certificate of survey or design compliance certificate was issued for this vessel, by a marine safety agency that fully implemented the USL code (at the time of issue):	Yes No
There is a record or means of verifying that the vessel has no unapproved modifications e.g. original stability book with GA:	Yes No

D. Alternate survey process proposal (as applicable)

In the applicable areas below, please describe the form of survey you propose to undertake, and reason(s) why you believe they should be approved.

Design phase survey

Survey activity	Form of survey proposed	Justification
Plan approval

Construction phase surveys

Survey activity	Form of survey proposed	Justification
Initial electrical survey
Initial fire systems and fit-out material survey
Initial fuel tank survey
Draft mark survey
Initial shaft survey
Watertight and weather-tight integrity survey
Initial engineering survey
Initial hull structure survey

Commissioning phase surveys

Survey activity	Form of survey proposed	Justification
Initial lightship check or inclining survey
Stability assessment
Commissioning survey

Renewal Phase surveys

Survey activity	Form of survey proposed	Justification
Renewal in water survey
Renewal out of water survey
Renewal shaft survey
Renewal lightship verification

E. List of supporting documents

F. Applicant’s declaration and consent

I declare that:

to the best of my knowledge the information provided by me in this application (and any attachments I have included with this application) is true and correct.

I consent to the Australian Maritime Safety Authority, as the National Regulator, making all reasonable enquiries in order to verify that the information provided by me in this application (and any attachments I have included with this application) is true and correct.

I understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, may ask that I provide any information or document that the National Regulator reasonably considers necessary for consideration of this application.

I understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, may ask another person to provide any information, document or agreement that the National Regulator reasonably considers necessary for consideration of this application.

I understand and acknowledge that a person is guilty of an offence under section 137.1 of the Criminal Code Act 1995 if the person gives false or misleading information, or omits anything without which the information is misleading, to a Commonwealth entity, to a person who is exercising powers or performing functions under a law of the Commonwealth, or in compliance or purported compliance with a law of the Commonwealth.

Signature	Name	Date

Privacy Statement The collection of information requested in this form is required or authorised by Schedule 1 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (the Act). It will be used for purposes related to the Act and may be provided to Commonwealth or State/Territory government agencies for the purposes of marine safety. Failure to provide the information may result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how your information may be used or disclosed for purposes beyond those described in this statement, visit www.amsa.gov.au/privacy.

How to lodge

Email applications to: dcvsurvey@amsa.gov.au