Application for personal certificate

Applicant data

Norwegian ID No. or D No.

First name
Last name
Address
Postcode
Postal area
Telephone
E-mail
The application is subject to fees. The fee must be paid before the
application can be processed.

Type name of the certificate for which you are applying:

The following shall be attached to the application form:

The list of qualification requirements printed from sdir.no. The
documentation described in the list of qualification requirements.
If you are applying for a duplicate of an existing certificate, you do not need to submit documentation of your
qualifications.

Select type of application:

Initial ☐ Renewal ☐ Duplicate ☐ Upgrade ☐

I confirm that the given information is correct and that the information may be used for
evaluation of certificate applications.

Date: Place:

Signature

Send to:
Norwegian Maritime Authority
P.O.Box 2222
NO-5509 Haugesund
Norway

Contact information:
If you need more assistance, please contact the Norwegian Maritime Authority. Please
remember to state the name/code of the certificate in your enquiry, which will make it easier to
find the correct person for your questions.
Tel.: + 47 52 74 50 00
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