Application for endorsement. Certificates of Competency and Certificate of Officer on fishing vessels.
Personal information
Date of birth Surname First and middle name Permanent address City Country Citizenship The application is subject to a fee, which must be paid in full before the application can be processed. The invoice and reply to the application will be sent to the company’s address.
Deck officer ☐ Certificate of officer on fishing vessels ☐
Engineer officer ☐ ETO ☐ GMDSS ☐ Send to Telenor Maritim Radio Motor ☐ Steam ☐
Description of national Certificate and endorsement: Certificate number Date issued Valid to Issuing country
Endorsement number Date issued Valid to Issuing country
Documentation: Required for Description of documentation Att. No.: All applicants Certificate of Competency Deck officer, ETO, Engineer officer, GMDSS according to STCW Convention or Certificate of officer on fishing vessels according to STCW-F Convention All applicants Passport photo Deck officer, ETO and Declaration of competence form Engineer officer Deck officer, ETO and Employment agreement and CRA Engineer officer (certificate issued by non-EEA maritime authority) For applicants Course in Norwegian maritime legislation (NIS course) serving as Master
KS-0377-21 – FS/USB Rev. 2015-04 Side 1 av 2 Norwegian Maritime Authority Application for endorsement.
Company and applicant information
Company’s name Company’s address in Norway - for innvoice and certificate Company’s telephone number Company’s e-mail Company’s organization number Name of ship and call sign Applicant’s position on board
I hereby certify that all information given by me in this application and the attached documentation is true and correct to the best of my knowledge.
Date of application:
Applicant’s signature:
Company representative’s signature and seal:
Application for endorsement of Certificate of Competency Deck officer, ETO, Engineer officer and certificate of officer on fishing vessels shall be sent by mail to the following address:
The Norwegian Maritime Authority P.O. Box 2222 N-5509 Haugesund NORWAY
Application for endorsement of GMDSS Radio Certificate shall be sent by mail to the following address:
Telenor Maritim Radio Radio Inspection P.O. Box 7150 (Ytrebygdveien 215) N-5020 BERGEN NORWAY
KS-0377-21 – FS/USB Rev. 2015-04 Side 2 av 2