MSF 4354 (version 12/23)
Application for GMDSS STCW Endorsement
Use this form for initial endorsement/revalidate a UK GMDSS GOC or ROC.
You do not need to use this form if revalidating a UK CoC at the same time
1. Personal Details
For details on how we use your information and your data rights, please see our privacy policy online
Title (Mr, Mrs, Miss, Capt. etc)
Surname/Family Name
First Name(s) in full
Date of Birth (DD/MM/YYYY)
Sex (male/female)
Place of Birth
Country of Birth
Nationality
Telephone Number
Email Address (capital letters)
2. Return Delivery Address
Address Line 1
Address Line 2 (optional)
Town/City
County/State/Province
Postcode/ZIP/PIN
Country
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3. Supporting Evidence
Failure to supply all the required documents is likely to cause a delay in the processing of this application
AMERC-issued GMDSS GOC or ROC
Valid ENG1 medical fitness certificate or MSN 1815 non-UK equivalent *
* DG Shipping India medicals must include ‘Annexure IV – Medical Certificate for Service at Sea’ page
Valid Certificate of Competency (IMO Whitelist)
If you don’t have a valid CoC, we will need to see the following STCW training certificates:
Initial GMDSS endorsement:
STCW A-VI/1-1 Personal Survival Techniques and refresher if older than 5 years old
STCW A-VI/1-2 Fire Prevention & Fire Fighting and refresher if older than 5 years old
STCW A-VI/1-3 Elementary First Aid
STCW A-VI/1-4 Personal Safety & Social Responsibility
GMDSS revalidation:
STCW A-VI/1-1 Personal Survival Techniques within the last 5 years
STCW A-VI/1-2 Fire Prevention & Fire Fighting within the last 5 years
4. Courier Fee
IMPORTANT NOTE: If you are sending documents from outside the UK and indicate to your courier
company that the documents have a value of over £100 GBP, you will be liable to pay any import
charges.
Payment should be made in pounds sterling (£) by bank transfer or debit/credit card via online payment facility
Gov.uk Pay (links below). We are unable to accept cheques, postal orders, banker’s drafts or cash
UK return delivery address:
| £10.00
https://www.gov.uk/payments/seafarer-training-courses/application-for-uk-courier-fees
EU/EEA return delivery address:
| £20.00
https://www.gov.uk/payments/seafarer-training-courses/application-for-eu-courier-fees
Rest of World return delivery address:
| £30.00
https://www.gov.uk/payments/seafarer-training-courses/application-for-row-courier-fees
If you wish to pay by bank transfer, please email [email protected] for our bank details
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I do not wish to pay the courier fee (your GMDSS slip will be sent by regular post – this is not trackable)
5. Declaration
The maximum penalty for a false declaration is £5,000
I declare that the data contained in this application is, to the best of my knowledge, true and complete. I also
declare that the documents are genuine, given and signed by the persons whose names appear on them.
Signature:
Today’s date: ………………………….
Submitting Your Application
Please ensure your documents are included as attachments or within a .zip folder. Unfortunately, we cannot
open .rar extensions or links to file-sharing services (for example OneDrive, Google Drive, Dropbox etc.)
Please email your completed form and photos/scans of your documents to [email protected]
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