Form 3 "Application for Certificate of Competency as a Coxswain/Coxswain-Driver/Driver" - Jamaica

Form 3 is a Maritime Authority of Jamaica form also known as the "Application For Certificate Of Competency As A Coxswain/coxswain-driver/driver". The latest edition of the form was released in March 15, 2010 and is available for digital filing.

Download an up-to-date Form 3 in PDF-format down below or look it up on the Maritime Authority of Jamaica Forms website.

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Form 3 "Application for Certificate of Competency as a Coxswain/Coxswain-Driver/Driver" - Jamaica

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Form 3 "Application for Certificate of Competency as a Coxswain/Coxswain-Driver/Driver" - Jamaica, Page 2

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Form 3 "Application for Certificate of Competency as a Coxswain/Coxswain-Driver/Driver" - Jamaica, Page 3

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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

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

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