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  • Attestation Form 2022 MI-271

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    Edith Uquichi Ccana
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    The document contains three application forms for seafarer documents from the Republic of the Marshall Islands Maritime Administrator. The first form is a general application for seafarer documents where the applicant affirms that all information provided is true and correct. The second form is a specific application for a Radio Operator's Certificate where the applicant acknowledges their obligation to maintain secrecy of communications and that their certificate can be suspended if this obligation is breached. The third form is an application for an Officer's Certificate at the management level where the applicant affirms that they have read and familiarized themselves with the national maritime legislation of the Republic of the Marshall Islands.

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    Attestation Form 2022 MI-271 (1)

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    The document contains three application forms for seafarer documents from the Republic of the Marshall Islands Maritime Administrator. The first form is a general application for seafarer documents where the applicant affirms that all information provided is true and correct. The second form is a specific application for a Radio Operator's Certificate where the applicant acknowledges their obligation to maintain secrecy of communications and that their certificate can be suspended if this obligation is breached. The third form is an application for an Officer's Certificate at the management level where the applicant affirms that they have read and familiarized themselves with the national maritime legislation of the Republic of the Marshall Islands.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    39 views1 page

    Attestation Form 2022 MI-271

    Uploaded by

    Edith Uquichi Ccana
    The document contains three application forms for seafarer documents from the Republic of the Marshall Islands Maritime Administrator. The first form is a general application for seafarer documents where the applicant affirms that all information provided is true and correct. The second form is a specific application for a Radio Operator's Certificate where the applicant acknowledges their obligation to maintain secrecy of communications and that their certificate can be suspended if this obligation is breached. The third form is an application for an Officer's Certificate at the management level where the applicant affirms that they have read and familiarized themselves with the national maritime legislation of the Republic of the Marshall Islands.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    REPUBLIC OF THE MARSHALL ISLANDS

    MARITIME ADMINISTRATOR

    APPLICATION FOR SEAFARER DOCUMENTS


    I hereby affirm that all information provided by me in applying for Republic of the Marshall
    Islands seafarer documents, inclusive of supporting documents and proofs, is true and correct to
    the best of my knowledge and belief; further, that no license, certificate or document issued to
    me heretofore by any government has ever been revoked or suspended, or, if revoked or
    suspended, a full explanation of the circumstances is attached hereto and made a part of my
    application.

    Signature of applicant Name of applicant (Surname, Given Names(s)) Date (month/day/year)

    APPLICATION FOR RADIO OPERATOR’S CERTIFICATE

    APPLICANTS MUST READ AND SIGN THIS OBLIGATION


    By affixing my signature below, I acknowledge that I am obliged to ensure and maintain the
    secrecy of all telecommunications of which I may gain knowledge in the course of my services,
    and that I am likewise obliged not to reveal the existence or contents of any correspondence to
    anyone other than the addressee. My signature further acknowledges that, if I should breach
    these obligations, my Certificate of Competence issued pursuant to this application may be
    suspended and/or revoked.

    Signature of applicant Name of applicant (Surname, Given Names(s)) Date (month/day/year)

    APPLICATION FOR OFFICER’S CERTIFICATE AT THE MANAGEMENT LEVEL

    APPLICANTS MUST READ AND SIGN THIS AFFIDAVIT/ACKNOWLEDGMENT


    These applicants include those for Master, Chief Mate, Chief Engineer, First Assistant Engineer,
    and Offshore Installation Managers on Mobile Offshore Units.

    I hereby acknowledge and affirm that I have read the publication MI-105A (“Familiarization
    with the National Maritime Legislation”), which is available for additional review online at
    www.register-iri.com. My review and ability to re-review this publication at any time, helps
    ensure that I have and will continue to become familiar with the national maritime legislation of
    the RMI relevant to the functions to be performed by me for which I have applied to be
    certificated.

    Signature of applicant Name of applicant (Surname, Given Names(s)) Date (month/day/year)

    May/2019 MI-271

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