NIOLLOWING DOCUMENTS A.

RE REQUIRED ALONG WITH APPLICATION FOR COC

(irr-ade:-

'I\rme;Illace of Birth:Date of Birth

i\ame and Place of birth is different is CDC and Passport, Notarized Affidavit to submit in (Original)
Yes

No

I
1

Filled page2, Rotation no. on pageT & Exn. 4!, Name, Date & Place of Birth
on 8.

j
4

Original Page No.7 & 8 of application and one Xerox. 1 No. Recent photograph Size 3.5*3.5mm (rvith Tie) pasted on Page no. 7 and endorsed by the Examiner. 4 Nos. photographs similar as above kept in smal envelope which to be pasted on the COC by DGS.
Rs.10001 Paid towards issue of COC (attached Copy of Challan on page 2). Copy of fbrm l5 to be retained by the candidate Copy of EXN-45 of all pageg, Copy of existing COC attached (if applicable) Copy of INDOS Certificate pertaining to Engineering Category. (Rating to Officer) Clear copy of CDC including relevant sea service pages Copy of Passport (all pages)

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1)

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l2 Valid Medical fitness Certificate in ILO form

l3
Copies of Advance Course as follows:

i)

Advance Fire Fighting

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iD iii)

Medical First Aid

PSC

.t

& RB

Copy of Engine Simulator / Preparatory Course (Management I Operational) if applicable Copies of Sea Service testimonials indicating Aftiele Time.and Propelling Days duly issued by Chief Engineer & Counter Signed by the Master of the Vessel.

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I g Copy of Letter issued by Owner of the vessel I Agent.

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2 sets of above documets (After examiner's signature) submitted.

One Green Envelope size l0*14 inches with Name, grade, Tel" No. Mobile No., E-Mail ID and Address of the Candidate.

Signature: Name of the Applicant:

C:

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