Application For An Assessment Of Overseas Qualifications For The Purposes Of A Migration Application Page 2

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SEAFARER’S APPLICATION FOR ASSESSMENT
OF OVERSEAS QUALIFICATIONS
FOR THE PURPOSE OF A MIGRATION APPLICATION
Applicant’s personal particulars
Given names
Family name
Date of birth
Town of birth
Country of birth
Nationality
Postal address for contact
Telephone number including country code
Email address
Postcode
Qualifications held
Applicants must hold a STCW primary certificate of competency and certified copies of all relevant certificates must be provided
Name and contact details of issuing authority
Level of certificate
Issue date
STCW endorsment
(include fax or mail address)
Cert. 1
Cert. 2
Cert. 3
College courses completed
Certified copies of all relevant course completion certificates must be provided
Course
Date completed
College/University
AMSA12 (4/16)
Page 1 of 2

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