Application for a Pilotage Exemption Certificate

CC 13 January 2016

Application for a Pilotage Exemption Certificate Marine Safety Act 2010 (Vic), Marine Safety Regulations 2012 (Vic), Marine Standard No. 6.3 Training and Certification of Pilot Exempt Masters for Victorian Ports

Things to know before applying Eligibility A pilot exemption certificate may be issued to a master of a vessel over 35 metres that is regularly visiting the Port of Melbourne, the Port of Geelong, the Port of Hastings, the Port of Portland or any other Victorian port subject to pilotage. To be eligible to be granted a pilot exemption certificate you must meet the following requirements:

Mandatory requirements Qualification You must hold one of the following: s  a valid and unlimited certificate of competency as a Master Class 1 issued by the Australian Maritime Safety Authority (AMSA); or  an equivalent certificate of competency issued by the relevant authority of a Flag State that is party to the International Convention on Standards of Training Certification and Watchkeeping of Seafarers 1995 and is formally recognised by AMSA; or  a certificate of competency otherwise accepted by the Safety Director (contact MSV for further information). You must be able to speak and understand English to a standard that will allow you to safely perform the duties and responsibilities of a pilot.

Medical and You must hold a current certificate of medical fitness (which includes eyesight requirements), eyesight certifying you are medically fit to perform the duties of a pilot exempt master. These certificates must be issued by an AMSA approved medical inspector within the previous six months of the date of this application. Bookings for medical examinations are administered by Medibank Health Solutions (MHS) on behalf of AMSA. You can book an examination by calling 1300 277 904 (toll free) or (03) 9224 8510. Further information about medical requirements is available in the Marine Orders Part 9 and Medical Examination Guidelines available on the AMSA website (amsa.gov.au).

Training You must:  attend as an observer, for at least five hours, on the navigation bridge of a tug operating within the relevant port/s unless otherwise specified by the Safety Director; and  visit the relevant port office and receive instructions in the operational procedures of that port.

Telephone 1800 223 022 PO Box 2797 Melbourne VIC 3001 Fax 03 9655 6611 121 Exhibition Street, Melbourne VIC 3000 Email [email protected]

of 13 CC 13 – 01/2016 Page 2 of 13 Things to know before applying (continued)

Qualifying You must complete the minimum number of qualifying trips for each relevant port, observing the trips operation of the vessel under the navigational charge of a pilot or pilot exempt master. All trips must be completed within the previous 12 months of the date of this application. For the ports of For the Port of For the Port of For any other Melbourne and Hastings Portland Victorian port Geelong You must complete: You must complete: Where the vessel to You must complete: Six (6) qualifying Six (6) qualifying rips be piloted is 80 Qualifying trips as trips inward and six inward and six (6) metres or less in the Safety Director (6) qualifying trips qualifying trips length you must requires. For other outward between outward between complete two (2) ports besides berth and sea berth and sea of qualifying trips Melbourne, Geelong, through Port Phillip which, one (1) inward and two (2) Hastings and Heads, of which one qualifying trip inward qualifying trips Portland, call MSV to (1) trip inward and and one (1) outward between discuss the qualifying one(1) trip outward qualifying trip berth and sea, of trip requirements. are in the hours of outward are in the which one (1) trip darkness; and hours of darkness; inward and one (1) and trip outward must be If you will be the in the hours of supernum If you will be the darkness. erary supernum For all vessels over master or erary 80 metres, you must chief master or complete: officer of a chief Three (3) qualifying vessel officer of a trips inward and under the vessel three (3) qualifying charge of under the trips outward of the a licensed charge of port and associated Pilot or a licensed channels, including Pilot Pilot or one (1) trip inward Exempt Pilot and one (1) trip Master Exempt outward in the hours and serve Master of darkness; and actively or and serve as an actively or If you will be the observer as an supernum on the observer erary navigation on the master or bridge of navigation chief such bridge of officer of a vessel, such vessel you must vessel, under the also you must charge of complete: also a licensed complete: Pilot or One (1) additional Pilot qualifyin One (1) additional Exempt g trip qualifyin Master inward g trip and serve and one inward actively or (1) and one as an addition (1) observer al addition on the qualifyin al navigation g trip qualifyin bridge of outward; g trip such and outward; CC 13 – 01/2016 Page 3 of 13 One (1) of the and vessel, qualifyin you must g trips One (1) of the also inward qualifyin complete: and one g trips (1) of inward One (1) additional the and one qualifyin qualifyin of the g trip g trips qualifyin inward outward g trips and one while the outward (1) vessel is while the addition under vessel is al the under qualifyin charge the g trip of a charge outward; Pilot. of a and Pilot. Where you intend to One (1) of the seek an qualifyin exemption g trips for both the inward Port of and one Melbourne (1) of and the Port the of Geelong, qualifyin you will be g trips required to outward complete while the the vessel is qualifying under trips for the each of the charge intended of a ports with Pilot. the exception of the passage through the South Channel which is common to both ports.

CC 13 – 01/2016 Page 4 of 13 Things to know before applying (continued)

Oral Within three (3) months of completing the required qualifying trips, you must pass an oral examination examination conducted by a Maritime Safety Victoria examiner. You must satisfy the examiner that you have a thorough understanding of all areas in the syllabus as outlined in Annex A of the Marine Standard No. 6.3 Training and Certification of Pilot Exempt Masters for Victorian Ports. For vessels over 185 metres LOA or of unusual design, you may be required complete further training or sit further examinations on the recommendation of the examiner. Check trips After you have passed the examination, you will be required to conduct a minimum of one (1) check trip in and one (1) check trip out of the relevant port/s. For these trips you will be navigating the vessel under the observation of a check pilot (examiner).You will be given further information about what check trips are required after the oral examination.

Fees and payment Applications incur an application fee, and oral examination fee and certificate issue fee. You must pay the application fee when lodging your application. The application fee can be paid by cheque or money order. A pilot exemption certificate cannot be issued until you have paid all fees.

Exemptions are valid for a period of two (2) years unless cancelled.

Attachments As part of the application you must attach the following mandatory supporting documentation:

a certified copy of your valid certificate of competency as a Master Class 1 issued by AMSA or an equivalent

certificate of competency issued by a Flag State that is party to the International Convention on Standards of Training Certification and Watchkeeping of Seafarers 1995 and is formally recognised by AMSA. a certified copy of your latest medical certificate and physical dockets.

a copy of the record of qualifying trips as recorded in an Excel spreadsheet and copies of trip dockets

provided by the pilotage service provider. a letter signed by a tug master confirming tug boat observer requirements have been met.

a letter from the relevant port office/s confirming your visit to receive instructions in the operational

procedures of that port. two (2) identical passport size photos (approximately H45mm x W35mm) with your signature on the back.

Photos must be less than 12 months old, showing a full front view of your head and shoulders without any head covering or tinted glasses. If you wear a head covering for religious reasons, a photograph showing your facial features is acceptable. If you normally wear prescription glasses, you must be wearing glasses with untinted lenses. The photograph must have a plain and lightly coloured background.

How to lodge Send your completed application and attachments by post to Maritime Safety Victoria, PO Box 2797 Melbourne VIC 3001.

What happens next?

 If the form is completed correctly and all necessary documents are attached, processing time is, on average, four (4) weeks.

CC 13 – 01/2016 Page 5 of 13  If requested by MSV, you may be required to provide further information including evidence of your qualifying trips.  If any change occurs in the information you have provided in your application, you must notify MSV as soon as possible.  MSV will write to you advising of the next steps, including an oral examination.

CC 13 – 01/2016 Page 6 of 13 Privacy Maritime Safety Victoria, a branch of Transport Safety Victoria (TSV) collects and holds the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Marine Safety Act 2010 (Vic) and Marine Safety Regulations 2012 (Vic). TSV is committed to protecting personal information in accordance with its obligations under the Marine Safety Act 2010 (Vic). The personal information provided in this application may be disclosed to other government agencies in accordance with section 306 of the Marine Safety Act 2010 (Vic) and section 177 of the Transport Integration Act 2010 (Vic). It is an offence under the Marine Safety Act 2010 (Vic) to give information that is false or misleading in order to obtain or attempt to obtain a certificate. The individuals whose personal information is collected on this application have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this application should be informed of this fact. For more information on privacy please refer to TSV's privacy statement at www.transportsafety.vic.gov.au/privacy.

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Application for a Pilotage Exemption Certificate Marine Safety Act 2010 (Vic), Marine Safety Regulations 2012 (Vic), Marine Standard No. 6.3 Training and Certification of Pilot Exempt Masters for Victorian Ports

Your details (the applicant) 1. Provide details of the certificate of competency you hold as a Master Level of certificate (e.g Master 1) Certificate number Issuing authority AMSA Other (specify)

2. Your surname Given names

3. Date of birth (dd/mm/yyyy) City or town of birth State Country Australia or specify

4. Gender Height (centimetres) Eye colour

Male Blue Brown Green Grey

Female Hazel

5. Hair colour Black Blonde Brown Grey Red Bald Other (specify):

6. Residential address Street number and name

Suburb State Postcode

7. Postal address Same as residential address

OR Street number and name/PO Box

8. Mobile number Daytime telephone number Same as mobile OR () Email Fax number (if applicable)

CC 13 – 01/2016 Page 8 of 13 ()

CC 13 – 01/2016 Page 9 of 13 Your employer details 9. Provide details of your employer Business name ABN

Postal address Street number and name/PO Box

Telephone number Fax number () () Email

Details of certificate required Ports and berths 10. For which port/s and berth/s is the pilot exemption certificate required? Port/s Berth/s

Port of Geelong

Port of Hastings

Port of Melbourne

Port of Portland

Other port (specify)

Vessels 11. For which vessel/s is the pilot exemption certificate required? Vessel name Call sign Where registered Gross Total Summer tonnage length draught (metres)

CC 13 – 01/2016 Page 10 of 13 Tug boat observer experience 12. Have you been a master on a tug within the previous 12 months? Yes  question 13.

No  Provide details of your tug boat observer experience (minimum of five hours is required)

Name of tug Port of registry Operations – Port area/berth Date Date to Number of from hours

Applicant’s photograph

13. Provide two (2) identical passport size photographs of yourself that are less than 12 months old with your signature on the back. Attach one below and include a second with this application.

CC 13 – 01/2016 Page 11 of 13 Declaration and signature

14. Applicant declaration and signature I declare that:  I hold a current and valid certificate of competency as a Master Class 1 issued by the Australian Maritime Safety Authority (AMSA) or an equivalent certificate of competency issued by a relevant authority of a Flag State that is party to the International Convention on Standards of Training Certification and Watchkeeping of Seafarers 1995 and is formally recognised by AMSA  I hold a current and valid medical certificate  I have undertaken and completed the required qualifying trips  I have been a master on a tug within the previous 12 months or attended as an observer for at least five hours on the navigation bridge of a tug operating within the relevant port/s  I have visited the relevant port office/s and received instructions in the operational procedures of that port  the supplied photographs are a true representation of me as the applicant  all particulars supplied on this application form and any attachments are true and correct. I understand it is an offence under section 305 of the Marine Safety Act 2010 (Vic) to provide any false or misleading information and that penalties apply.

Signature of applicant Date X

Privacy Maritime Safety Victoria, a branch of Transport Safety Victoria (TSV) collects and holds the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Marine Safety Act 2010 (Vic) and Marine Safety Regulations 2012 (Vic). TSV is committed to protecting personal information in accordance with its obligations under the Marine Safety Act 2010 (Vic). The personal information provided in this application may be disclosed to other government agencies in accordance with section 306 of the Marine Safety

CC 13 – 01/2016 Page 12 of 13 Act 2010 (Vic) and section 177 of the Transport Integration Act 2010 (Vic). It is an offence under the Marine Safety Act 2010 (Vic) to give information that is false or misleading in order to obtain or attempt to obtain a certificate. The individuals whose personal information is collected on this application have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this application should be informed of this fact. For more information on privacy please refer to TSV's privacy statement at www.transportsafety.vic.gov.au/privacy.

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