1
2
3FORM III
□
New
APPLICATION FOR CERTIFICATE OF COMPETENCY AS A
□
Renewal
COXSWAIN/COXSWAIN-DRIVER/ DRIVER
□
Upgrade
TO: Maritime Authority of Jamaica
□
Re-issue of Certificate
Kingston
Licence No: _____________________________________
Issued on: _______________________________________
Pursuant to Rule 38 of the Harbour Rules, 1971, I hereby make an application for a Certificate of
Competency to operate a Coxswain/Coxswain- Driver/Driver *of a boat/vessel.
Full Name of Applicant _________________________________________________________________
Address of Applicant ___________________________________________________________________
Date of Birth _____________________________ Telephone Contact ___________________________
Tax Registration Number _______________________________________________________________
Name of Organization __________________________________________________________________
Previous Experience of Applicant: ________________________________________________________
____________________________________________________________________________________
Harbour/Harbours* within which the applicant desires to operate as a Coxswain/Coxswain Driver*:-
____________________________________________________________________________________
Type and Horsepower (B.H.P (kW) of the engine, which the applicant desires to operate as a Driver
/Coxswain Driver*: -
____________________________________________________________________________________
I submit herewith two (2) passport sized photographs of myself taken not more than three (3) months and
endorsed by a Justice of the Peace (JP), Inspector of Police or gazetted Police Officer.
DATED this ___________________day of ________________________ ______________________
Signature of Applicant
(Please sign in the box)
This is to certify that the applicant is to the best of my knowledge and belief, a person of good character
and sober habits, and has been known to me for a period of _________________________________ years.
_______________________________________
Inspector or Officer of Police/Justice of the Peace
For the parish of:________________________
/ Rev. No. 02/March 15, 2010
FORM III
□
New
APPLICATION FOR CERTIFICATE OF COMPETENCY AS A
□
Renewal
COXSWAIN/COXSWAIN-DRIVER/ DRIVER
□
Upgrade
TO: Maritime Authority of Jamaica
□
Re-issue of Certificate
Kingston
Licence No: _____________________________________
Issued on: _______________________________________
Pursuant to Rule 38 of the Harbour Rules, 1971, I hereby make an application for a Certificate of
Competency to operate a Coxswain/Coxswain- Driver/Driver *of a boat/vessel.
Full Name of Applicant _________________________________________________________________
Address of Applicant ___________________________________________________________________
Date of Birth _____________________________ Telephone Contact ___________________________
Tax Registration Number _______________________________________________________________
Name of Organization __________________________________________________________________
Previous Experience of Applicant: ________________________________________________________
____________________________________________________________________________________
Harbour/Harbours* within which the applicant desires to operate as a Coxswain/Coxswain Driver*:-
____________________________________________________________________________________
Type and Horsepower (B.H.P (kW) of the engine, which the applicant desires to operate as a Driver
/Coxswain Driver*: -
____________________________________________________________________________________
I submit herewith two (2) passport sized photographs of myself taken not more than three (3) months and
endorsed by a Justice of the Peace (JP), Inspector of Police or gazetted Police Officer.
DATED this ___________________day of ________________________ ______________________
Signature of Applicant
(Please sign in the box)
This is to certify that the applicant is to the best of my knowledge and belief, a person of good character
and sober habits, and has been known to me for a period of _________________________________ years.
_______________________________________
Inspector or Officer of Police/Justice of the Peace
For the parish of:________________________
/ Rev. No. 02/March 15, 2010
FOR OFFICIAL USE ONLY
To:
Surveyor General
I examined the
________________________________________ on ___________________________
(
)
(
Name of Applicant
Date Examined)
for seamanship, navigation, operational safety and “rules of the road”. The applicant demonstrated boat
handling competence and specific local knowledge for safe navigation for the port(s) of: -
______________________________________________________________________________________
______________________________________________________________________________________
*
and I recommend that the applicant be granted a Coxswain/Driver/Coxswain-Driver
Certificate for the
port (s) of:-____________________________________________________________________________
______________________________________________________________________________________
and for Class ________ vessels with inboard and outboard Diesel and/or Petrol* engine(s) not greater
than ____________________ B.H.P (kW) rating.
______________________________________
Examiner, Maritime Authority of Jamaica
OFFICIAL USE ONLY
Payment Details
___________________________
______________________ _________________________
__________________
Receipt Number
Receipt Amount
Date
Cashier’s Signature
___________________________
____________________________
Date of Application
Reviewing Officer
Examination Details
____________________________
_________________________________
_______________________________
Date of Examination
Name of Examiner
Signature of Examiner
*
Delete as appropriate
/ Rev. No. 02/March 15, 2010
REQUIREMENTS FOR COXSWAIN CERTIFICATE
The following must be submitted in applying for a Coxswain Certificate.
New
1.
Complete an application Form for Coxswain Licence and submit along with:-
(i) Two (2) certified passport-sized photographs taken not more than three (3) months
(ii) The relevant fees.
Renewal
2.
Complete an application Form for Coxswain Licence and submit along with:-
(i) The expired Booklet or Certificate.
(ii) A letter from previous company (ies) or otherwise demonstrating at least twelve (12)
months employment during the five (5) years period of your Licence.
(iii) Two (2) certified passport-sized photographs taken not more than three (3) months
(iv) The relevant fees.
Upgrade
3.
Complete an application Form for Coxswain Licence and submit along with:-
(ii) The current Booklet or Certificate.
(iii) Two (2) certified passport-sized photographs taken not more than three (3) months
(iv) The relevant fees.
Re-issue of Certificate
For the re-issue of a Coxswain Certificate whether it has been lost or destroyed, you will be required
to submit:
(i)
An application for replacement of lost or destroyed certificate.
(ii)
A police report or report from the Fire Department where the loss is due to theft or
fire respectively.
(iii)
The relevant fees.
In order to ensure we continue to meet your expectations of service, you are asked to submit the
necessary documents at least three (3) weeks in advance.
Please note that no services will be provided without the submission of all the necessary documents
and payment of the relevant fees.
For fees or additional information, please visit our website at
www.jamaicaships.com
or call
(876) 929-2201.
/ Rev. No. 02/March 15, 2010
