Application For An Assessment Of Overseas Qualifications For The Purposes Of A Migration Application Page 3
ADVERTISEMENT
1
2
3Sea service details
The following must be provided:
– certified copies of a discharge book pages / watchkeeping certificates
– company letters (not from ships) verifying details of service. Letters must be originals on company letterhead and state;
names of vessels, IMO number, gross tonnage, position held and dates of service
(see AMSA 419 Information Guide at: ).
GT /
Type
Position
Length of service
IMO
Ship name
Engine
of
on
number
From (date)
To (date)
KW
ship
board
If insufficient space, please attach extra page
Short course details -
certified copies of all short course certificates to be provided
Name of course
Course provider
Date completed
First aid - Medical first aid/Medical care on board
Fire fighting - Advanced
Survival - Proficiency in survival craft & rescue boats
Security Awareness Training/Ship Security Officer
Practical training ashore (Engineers only)
Declaration
WARNING:
Personal information collection
statement
Giving false or misleading information is a serious criminal offence.
The Australian Maritime Safety Authority
To the best of my knowledge, the information given by me on this application is true and
(AMSA) is collecting the information on this
correct in every detail.
form to assess your overseas qualifications
I have attached a certified copy of my current passport
for the purposes of a migration application.
It will be used for purposes related to that
assessment, including the creation of a
Date
Applicant’s signature
Seafarer ID for future reference by yourself
/
/20
and AMSA, and treated in accordance with
the Australian Privacy Principles.
Please note: There is a assessment fee of A$472, payable to AMSA which must be paid
This information may be exchanged
before this application can be processed.
between AMSA and the Department of
Do not send cash with this application form via mail as this is an illegal action and there
Immigration and Border Protection. Failure
to provide the information may result in
is a high possibility of it being lost in transit.
the transaction not being processed. To
Send completed application, together with assessment fee to:
contact us, or for more information on
Australian Maritime Safety Authority
how to access or correct your personal
information, how to make a privacy
Shipping Qualifications
complaint, or how your information may
GPO Box 2181
be used or disclosed, visit AMSA’s privacy
Canberra City ACT 2601
policy at
AUSTRALIA
Fee payment methods
1. By bank draft/cheque made payable in Australian dollars to Australian Maritime Safety Authority
2. By credit card (VISA or Mastercard only) - Phone +61 2 6279 5000
Please include the applicant's name and reason for payment on all deposits / correspondence.
AMSA12 (4/16)
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
A.p.f.c. Form - 12 - Form Of Application By A Government Servant For An Advance For The Purpose Of Purchase Of A Motor Car
Business
Form Rv-f1300601 - Affidavit To The Commissioner Of Revenue For The Purpose Of Filing An Application For A Certificate Of Title Without Payment Of Sales Or Use Tax
Financial
Form Str-23 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Corporation For The Sole Purpose Of Conducting Medical Research Or For The Purpose Of Establishing
Financial
Form R-1070 - Application For Certification As A Manufacturer Or Farmer For The Purpose Of The Sales/use Tax Exclusion For Manufacturing Machinery And Equipment
Financial
Form N-14-1 Declaration By An Authorised Dealer Purchasing Goods For The Purpose Referred To In Sub-section (1) Of Section 11 Of The Bombay Sales Tax Act, 1959
Financial
Related Categories
Parent category: Business