COMPANY OF MASTER MARINERS OF INDIA (CMMI) KOCHI CHAPTER
Form No: DCE –Ver 2 Dtd 25 Feb 2015
Application for Issuance of Certificate (Endorsement) for Service on Tankers
(Dangerous Cargo Endorsement)
Particulars of Candidates :-
(1) Name: (in Block Letters)
First Middle Last
(2) Date Of Birth (DD/MM/YYYY) / / Place of Birth
(3) Current Rank
(4) Phone Number - landline :-
Mobile :- Passport
(5) E-Mail id Size
Photo
(6) CDC Number (7) Passport Number
(8) INDoS Number
(9) Issuance of Certificate (Endorsement) of Service on Tankers requested as follows:
Type of Tanker Level #
Oil / Chemical / Liquefied Gas* Tanker Level 1
(10) Record of Sea Service (On Type of Tankers for which endorsement is sought)
Total Time
Vessel’s Particulers Duration Served Served (Years / Cargo Carried
Rank Months / days)
Served
Port of
Name Type From To
Registry
Candidates Signature : ___________________________ Date: ___________________
(FOR OFFICIAL USE)
Fees paid: Challan No: Office Assistant: ……………....…….
I have scrutinized above application in line with applicable guidelines.
Candidate is Eligible / Not Eligible for Issuance of Certificate (Endorsement) for service on Tankers as
requested and may be issued.
Endorsement No: ……………………… Signature of Duly Authorized Officer: ………………………..
Dated : ……………………… Name of Officer…………………………..……………………
In Capacity of : ……………………… Designation : …………………………………………………..
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COMPANY OF MASTER MARINERS OF INDIA (CMMI) KOCHI CHAPTER
Form No: DCE –Ver 2 Dtd 25 Feb 2015
Declaration Form and Checklist for Dangerous Cargo Endorsement for Level 1 Deck
Ratings & Deck Cadets
NAME: _____________________ RANK : ______________________ INDoS No. : ______________________
Following documents are to be attached along with application form for dangerous cargo endorsement in the same
sequence as listed.
SR. DESCRIPTION OF DOCUMENT YES NO
NO.
1 Application Form in original duly filled up & signed by the candidate.
2 Checklist & Declaration form duly filled.
3 Copy of INDoS Certificate
4 Copy of updated Seafarer Registration Print Out on E-Governance of DG Shipping.
5 Copy of INDOS Checker from DG Website.
6 Copy of CDC (All Stamped pages)
7 Copy of Passport (All Stamped pages)
8 Copy of below listed Course Certificates
(a) Personal Survival Technique (Refresher course to be done if date of issue is older than 5 years)
(b) Fire Prevention & Fire Fighting (Refresher course to be done if date of issue is older than 5 years)
(c) Elementary First Aid.
(d) Personal Safety & Social Responsibility (STCW 2010 or Upgradation course of PSSR for those holding
STCW 95 PSSR Certificates)
(e) Copy of Oil / Chemical / Liquid Gas Familiarization Course Certificate.
(f) Copy of Certificate of having undergone the Augmentation of Fire Prevention and fire fighting course.
9 Original Old Level 1 DC Endorsement (in case of renewal).
10 3 months experience appropriate to duties on the type of tanker within last 5 years (For DC Renewal )
11 Original letter issued by the owner of the vessel / Agent regarding sea service with RPSL Number &
e-mail Address. (For Renewal of DCE ).
12 Copy of Medical Fitness Certificate (DGS approved Doctor) taken within last 1 year.
13 Three recent colour photographs - passport size (3cm*4cm) with light background.
14 Fees applicable to MMD, Bank Charges & CMMI -FC.
15 One cloth envelope size 10 * 14 inches with contact details (including name, rank, contact no. /e-mail)
Note:
1) Updated Seafarers Registration is Compulsory for all Candidates at the time of application of Dangerous Cargo
Endorsement.
2) The Company Sea-time letter should also mention the name of Oil /Chemical /Gas Cargo carried along with their grade.
3) All relevant Original documents are to be produced while submitting the applications for verification and also at the time of
collecting the certificate.
4) Candidate should ensure that form is correctly filled up and that all required documents are attached as per the above
checklist in the same order.
5) Candidates are reminded that Fees once paid cannot be reimbursed in case the application is rejected for any reasons.
Declaration: I make this solemn declaration and conscientiously believing that the statements contained in this application
form to be true in every particular. I understand that any incorrect information or non-disciplinary action from my side may
result in refusal of my application or, if a certificate has been granted, the cancellation of that certificate.
Candidates Signature : ___________________________ Date: ___________________
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