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     HONG KONG MARINE DEPARTMENT

香港海事處

Application for Revalidation of Certificate of Competency and/or

Dangerous Cargo Endorsement

適任證書重新生效 / 危險貨物簽證申請表

 
You should read the notes on page 3 carefully before completing this form.   填寫此申請表時﹐請參閱第3頁的附註。
 

1  Type of Application required 申請種類    

     


 Please select application and tick the appropriate box.   請選擇所需申請,並於適當的方格內加上[ü]號
 
    c   Application for revalidation of certificate of competency 適任證書重新生效申請  

    c   Application for dangerous cargo endorsement (oil tanker) 危險貨物簽證(油輪)申請

 

    c   Application for dangerous cargo endorsement (chemical tanker) 危險貨物簽證(化學品液貨船)申請

 

    c   Application for dangerous cargo endorsement (liquefied gas carrier) 危險貨物簽證(液化氣體船)申請

    
 

2  Personal Details 個人資料    

Surname 姓                                  Forenames 名


     

Chinese Name中文姓名(if applicable如適用) Sex 性別 Date of Birth出生日期 Place of Birth出生地點 Nationality國籍


        (DD日/ MM月/YY年)        

Passport/Travel Document/Identity Card Number Date & Place of issue of passport/travel document

護照/旅遊證件/身分證編號 護照/旅遊證件發證日期及地方


     

Correspondence Address聯絡地址 Correspondence 聯絡方式


    Tel.  電話
    Fax  傳真
    Email電郵

Seafarer's Employment Registration Book Number Date and Place of Issue of Seafarer's Employment Registration Book

海員僱用登記簿編號  海員僱用登記簿簽發日期及地方


     
 

3  Certificate of Competency and Dangerous Cargo Endorsement held 現時持有之適任證書及危險貨物簽證    

     


Class

級別

Certificate No.

證書編號

Date of Issue

發證日期

( DD日/ MM月/YY年 )

Date of Expiry

有效日期至

( DD日/ MM月/YY年 )

Type of Dangerous Cargo Endorsement issued, if any

已持有危險貨物簽證種類

   
 
     
 

4  Return of Document 取回證件    

     


Please indicate, by ticking appropriate box, if you wish to collect your documents in person or receive them by post

請表明選擇取回證件之方法並於右列方格內加上[ü]號

c   Collect in Person親身取回

c   By Post 郵寄方式取回

Address for return of documents 以郵寄方式取回文件之地址:               Address for return of documents 以郵寄方式取回文件之地址:


姓名

Name                                               

    姓名

Name                                               

地址

Address                                             

    地址

Address                                              

 
                                                                                                                    
     
                                                                                                                      
 
                                                                                                                   
     
                                                                                                                      

5  Training Course attended for Dangerous Cargo Endorsement 已就讀的危險貨物簽證培訓課程    

 
Title of Course

課程名稱

Training Institutes

培訓機構

Issue Date of Training Certificate

培訓證書簽發日期

 
 
 
   
 

6  Shore Employment 陸上職業

     


Name of Employer

僱主名稱

Post

職位

Duties

職責

Duration of Service 服務日期
From 自 To至
 
 
 
 
       
 

7  Sea Service 航海服務    

     


Particulars of ship船隻資料 Date

日期

 
 
Ship's Name

船名

 
Type of

Ship

船隻類別

(Note 5)

 
Gross

Tonnage

總噸

Type of engine

(Motor or Steam)

and Power

主機類別

(內燃機或蒸氣機)

及馬力

Port of

Registry and

Official No.

註冊港口

註冊編號

 
 
Rank

職級

 
From

 

(DD日 / MM月/YY年)

 
To

 

(DD日 / MM月/YY年)

               
               
               
               
               
               
               
 
 
 

                                       The penalty for making a false declaration is $50,000 and imprisonment for two years

  8  Declaration聲明書

                                    提供虛假資料可被罰款五萬元及監禁兩年

 
 

I declare that the information I have given in this application form is as far as I know true and complete. I also declare that I am the rightful holder of the attached certificate of competency as described in section 3.

本人謹此聲明﹐在此申請表內所呈報的資料均屬真確,並無遺漏。並在此聲明本人為第三項所填報的適任證書合法持有人。


 
 
Signed 簽署
 
 
 
 
 
Date 日期
 
 
 
 
 
 
 
 
 
 

M.O. 899 (Rev.12/2016)              此申請表免費發給               THIS APPLICATION FORM IS ISSUED FREE OF CHARGE

 
 
NOTES  

Please read the following notes before completing the application form:

 

General

    1. The form should be completed in English block letters as far as practicable.

    2. Applications may be submitted in person or by post to the Seafarers' Certification Section, Marine Department, Room 303 3rd Floor, Harbour Building, 38 Pier Road, Hong Kong.  .

 

Personal Details

    3. Surname and forenames are to be entered with a reference to that on the certificate of competency held by the applicant.

    4. Seafarer's Employment Registration Book means the official sea service record book held by the applicant.  The record book is sometimes referred to as Seamen's Discharge Book or Continuous Discharge Certificate.

 

    Type of Ship

    5. Enter the following types of ship: Cargo, Oil Tanker, Chemical Tanker or Liquefied Gas Carrier.

 

Fee

    6.   The prescribed fee must be submitted with the application form.  All cheques, drafts and orders should be made payable to "The Government of the HKSAR". Cash should not be sent by post, and post dated cheques will not be accepted. The fees required are as follows:-

a. For revalidation HK$530
b. For dangerous cargo endorsement Free of Charge
 
 

7.   Each application should be accompanied by:

a. The original of the applicant's certificate of competency (photocopy will not be accepted).
b. A certified copy of valid certificate of medical fitness issued by an approved medical practitioner.  The certificate of medical fitness
  1. is not to be valid for more than two years from the date of issue in respect of a seafarer below 55 years of age;  or
  2. is not to be valid for more than one year from the date of issue in respect of a seafarer 55 year of age and over or in respect of a seafarer serving or intending to serve on bulk chemical carriers.
c. For the application of revalidation, evidence of:
  1. Service as a master or deck officer in sea-going ships or engineer officer in sea-going ships of 350kW registered power or more for at least 12 months during the preceding 5 years; or
  2. Have satisfactorily completed an approved shore based updating course; or
  3. Have completed not less than 3 months sea services on ships in a supernumerary capacity or in a lower officer rank than that for which the certificate held is valid immediately prior to taking up the rank for which it is valid; or
  4. Service in occupations appropriate to the class of certificate held which are considered to be at least equivalent to the sea service referred to in para. 7.c.i above. Such service should have been engaged for at least half of the preceding 5 years period. A statement from the applicant's employer or supervisor with a detailed description of the applicant's duties should be provided.
d. Class 1 and Class 2 Certificate holders who wish to have their dangerous cargo endorsements revalidated must in addition to meeting the basic updating requirement, should provide evidence of at least 3 months service (which need not be continuous) in tanker in the preceding 5 years; or at least 6 months on a storage tanker, barge or terminal in operations involving loading or discharging of tankers during the preceding 5 years. An officer who has not served in a tanker or equivalent during the preceding 5 years period will have his dangerous cargo endorsement or endorsements withdrawn. 
e. For new application for dangerous cargo endorsement, evidence of completion of an approved training course on the carriage of the relevant dangerous cargo. For Class 1 and Class 2 Certificate holders, additional evidence of an appropriate period of shipboard training or service.
 
 

Personal Data

    8.  The information  provided  will  be used for the application of revalidation/dangerous cargo endorsement and may be divulged to departments/agencies authorised to process the information for the mentioned purposes. Limited personal data of successful applicants may be used via the Marine Department's Internet web site for verification of the issued certificate by any third parties.

 

    9.   The supply of information is obligatory.  Please ensure that all related parts in the form are completed and the information provided is accurate.  Failure to do so may result in unsuccessful application.  For correction of or access to personal data after submission of this form, please contact the Officer-in-charge, Seafarers' Certification Section, Marine Department (Room 303, 3/F., Harbour Building, 38 Pier Road, Central, Hong Kong).

   
備  註  

填寫此申請表時,請參閱以下的備註:

 

一般

1. 請盡可能用英文正楷填寫此表格。

2. 申請人可以親身或以郵寄方式至海事處海員發證組 (香港中環統一碼頭道38號,海港政府大樓3字樓303室) 辦理手續。

 

個人資料

3. 姓氏及名字須參考持有的適任證書填寫。

4. 海員僱用登記簿指申請人持有的正式航海服務紀錄簿。這本紀錄簿有時亦稱作海員辭職證書或連續辭職證書。

 

船隻類別

5.  請填寫以下船隻類別: 貨輪、油船、化學品液貨船 或 液化氣體船。

 

費用

6. 呈交申請表時必須連同所需費用一起提交。所有支票、電*徽憬M本票受款人均須寫上"香港特別行政區政府",並加以劃線。切勿郵寄現金,未到期的支票將不予接受。所需費用如下:

a. 適任證書重新生效 HK$530
b. 危險貨物簽證 免費
 
 

7.  呈交申請表時必須連同下列證件一起提交:

a. 適任證書正本 (副本不予接受)。
b. 由認可醫生簽發的有效健康證明書。健康證明書的有效期
i 就55歲以下的海員而言,有效期最長為2年;或
ii 就55歲或以上或在散裝化學品運載船上服務或擬在該類船舶上服務的海員而言,有效期最長為1年。
 
c. 呈交適任證書重新生效申請時必須呈交以下證明:
i 於過去5年內,至少於海域航行船上完成為期12個月的船長或甲板部高級船員之服務或於註冊動力不少於350kW的海域航行船上的輪機師服務;或
ii 圓滿地完成認可的有關課程;或
iii 完成不少於3個月後補職位的船上服務或在任職前3個月內完成較持有有效適任證書低一級之職位的船上服務;或
iv 與證書之職級或職能相若的職業而該職業被認為等同於上列第7.c.i段的船上服務,並於過去5年內的一半時間需任職於該等職業。僱主或其監督需提供陳述書詳細記載申請人職能範圍之資料。
 
d. 一級及二級證書持有人如欲將證書內危險貨物簽證同時辦理重新生效,除需符合續牌條件外,必須呈交證據證明於過去5年內有不少於3個月的液貨船服務(期間不一定為連續服務);或於過去5年內不少於6個月於貯藏性液貨船、駁船或碼頭從事裝卸液貨船等有關服務。任何高級船員於過去5年內並沒有上述之液貨船服務,其有關的危險貨物簽證將被撤銷。
e. 首次危險貨物簽證之申請均需提交完成認可的相關課程之證明。一級及二級證書持有人需額外提交所需之船上培訓或服務證明。
 
 

個人資料

8. 申請人所提供的資料會用作申請執照之用,並可能送交執法機構及有關部門,以便進行與其有關的事宜。成功申請人的有限個人資料可能會用於海事處的互聯網址以供第三者查證本處所發出的執照。

 

9.  申請人必須填妥申請表各項,並提供正確資料,否則申請表可能不獲受理。在遞交表格後,如要更改或索閱其個人資料,請與海事處海員發證組主管人員聯絡 (香港中環統一碼頭道38號,海港政府大樓3字樓303室)。


 

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