INTERNATIONAL SEAFARER CERTIFICATES –

AMSA 419
Navigation Act 2012
Marine Order 70 series

Guidance on how to use this form

AMSA Form 419 is used to apply for various international certificates. For domestic near coastal certificates use AMSA Form 426

You must answer all questions on the form and select Download pdf once completed. To lodge, you will need to print the completed
form. You will need to provide supporting documents for each item on the checklist which is generated by the form. If you do not
provide all the required documents, we cannot guarantee that your application will be processed within 28 days.

Additional Information
Please note that lodgement of this form DOES NOT automatically entitle you to receive the certificate or endorsement applied for, nor does it
indicate acceptance of sea service. The final decision with regards to the issue of a certificate or endorsement is made by the Manager, Seafarer
Certification Service.

How to submit your application

This form cannot be submitted online; it must be printed prior to lodging. Once complete, please click 'Download PDF' at the top right
corner of this form, and then print.

Lodging from within Australia:

If you are applying within Australia you are required to lodge your application in person at an Australia Post outlet. For the list of
participating Australia Post retail outlets please see the following webpage.

Lodging from overseas:

If you are lodging from overseas please see the following webpage

AMSA form 419, Page 1 of 9

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Proof of identity
Proof of identity is required when applying for a certificate of competency, certificates of proficiency, certificate of safety training or
seafarer’s service book.
Proof of identity is necessary to protect your identity, as well as our certification system.
Documents submitted as part of your proof of identity must be originals. You must present your documents to Australia Post at the time of lodging
your application. Find a participating Australia Post outlet.

Five identity options

You must choose one of these five identity document options:

Option 1
Submit the following:
• Your current passport

Option 2
Submit the following:
• Your current Australian driver’s licence
• Your full Australian birth certificate or your Australian citizenship certificate

Option 3
Submit the following:
• A photographic identification document issued by an Australian Commonwealth, state or territory government agency
• Your current Australian Medicare card
• Your full Australian birth certificate or your Australian citizenship certificate

Option 4
Submit the following:
• Your current Australian Medicare card
• A current account card from a bank that shows your signature
• A proof-of-age card or student ID card that shows your photograph
• Your full Australian birth certificate or your Australian citizenship certificate

If the name on the identification documents (passport, driver’s licence, birth certificate, or citizenship certificate, etc) does not match the name on
your application form, you must submit a copy of a change of name document to show your official name change.

Option 5 - Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people born from 1969 onwards may be able to access their birth certificate through the births, deaths and
marriages registry in the state or territory of their birth.
Aboriginal and Torres Strait Islander people born earlier than 1969 who do not have a birth certificate may be recorded in the Aboriginal Population
Register available from the Northern Territory Registry of Births, Deaths and Marriages. We will accept this document as equivalent to a birth
certificate.
If an Aboriginal or Torres Strait Islander person cannot provide proof of identity as required above, a completed Identity declaration for Aboriginal
and Torres Strait Islander person form 162 will be accepted as being equivalent to option 1 (current passport).

AMSA form 419, Page 2 of 9

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Application
Sea Service Assessment - Deck and Engineer Officers including Recognition (not applicable for Rating)
Certificate and/or endorsement (COC Deck and Engineer Officers require positive AMSA Sea Service Assessment)
Replacement of a certificate or endorsement (only to be used if your existing certificate is lost/stolen/damaged or change of
personal details)
Recognition of certificate, initial issue and revalidation of recognition (prerequisite for initial issue: positive AMSA sea service
assessment)
Revalidation of a certificate or endorsement
Australian Seafarer’s Service Book
Assessment only for Royal Australian Navy Navigation Seaman Officers and Royal Australian Navy Engineering

Checklist for supporting documents

A checklist must generate with this form. All documents listed on the checklist must be handed to the Australia Post Officer with this application
form. Overseas applicants only: Attach passport photo and sign in the specimen boxes on the last page. Your form will need to be lodged by
post.

You must provide copies of all supporting documents including sea service letters. Overseas applicants must send certified copies. Do not send
original documents. AMSA will not accept any liability for documents lost in transit.

Your application will not be processed until we receive a complete application with all document/s in the checklist.

When submitting qualifying sea service letters to support an application, the applicant must provide copies. Overseas applicants must
send certified copies.

When submitting course completion statements to support an application the applicant must provide copies and keep original documents in their
possession. Overseas applicants must send certified copies.

If this is not complied with the application will not be processed until AMSA receives a copy of the document(s) mentioned above. AMSA will not
accept any liability for documents lost in transit.

AMSA form 419, Page 3 of 9

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Checklist
Certificate of Safety Training – Initial issue

✔
AMSA approved short courses as follows –

• personal survival techniques

• fire prevention and fire fighting
• elementary first aid
• personal safety and social responsibilities
• security awareness training

• AMSA does not accept STCW Reg VI/1 Basic Safety courses completed overseas or from colleges within Australia not approved by AMSA.
• A Certificate of Medical Fitness is NOT required for the issue of this certificate

Note to Australia Post – course completion statements may be accepted either listing a single course or multiple courses.

AMSA form 419, Page 4 of 9

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Personal details
Seafarer ID Title Surname

Mr Tait
Given names

Ian

Your certificate will be issued using your name as it appears on your Proof of Identity document. Please ensure your name is entered as
it appears on your identification document.

Nationality Date of birth

Australian 15/11/1997

Gender
Male Female Indeterminate/Unspecified/Intersex

Permanent address (for contact)

Address type
Australian street Australian delivery address Overseas

Street name and number Town/suburb State Postcode

15 may st bayswater Bayswater Wa 6053

Country

Australia

Is your delivery address different from above? ✔

Delivery address
Address type
Australian street Australian delivery address Overseas

Street name and number Town/suburb State Postcode

Whitsunday sailing club Airlie point Airlie beach Ian tait Airlie beach Qld 4802
Country

Australia

Telephone numbers (for contact if necessary)

Home Mobile Other

0450501393

Email address
Email

[email protected]

AMSA form 419, Page 5 of 9

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Certificate/s currently held
For Navigational Watch Rating or Engine Room Watch Rating applications, fill-in details of your Certificate of Safety Training with security
awareness endorsement below.

Type of certificate

Capacity

Certificate number Country of issue Issue Date

Australia

Certificate/s applied for

Select the category of competency that you are applying for:

Engineer officer Deck officer Rating (including Marine Cook and Certificate of Safety Training)

Type of Certificate - Rating, Cook, Certificate of Safety Training

Certificate of Safety Training
Type of Certificate - Rating, Cook, Certificate of Safety Training
Designated safety, pollution-prevention duties and security duties

Endorsement/s applied for

Leave this section blank if you are not applying for an endorsement. DO NOT apply for a new endorsement if you hold a current endorsement of
the following:

• Security Awareness Training (SAT)

• ECDIS
• Ship Security Officer
• Designated Security Duties
• Advanced Fire Fighting
• Proficiency in Survival Craft and Rescue Boats other than Fast Rescue Boats

Endorsement Type

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Payment
Description Fee

Designated safety, pollution-prevention duties and security duties $112

Total Payable Fee $112

Please lodge your application with supporting documentation and pay at your nearest participating Australia Post retail outlet. To find the nearest
participating outlet, please go to www.amsa.gov.au. A tax invoice for your fee payment will be issued to you when your application has been
processed

AMSA privacy policy

The Australian Maritime Safety Authority (AMSA) is collecting the information on this form to determine if you are eligible for the issue of a:

• Certificate of competency or certificate of recognition as a master, deck or engineer officer or GMDSS ROC; or
• Certificate of proficiency, rating or safety training in order to serve as a seafarer.

The collection of the information is required, authorised or directly related to the Navigation Act 2012 and the Marine Orders made under it. It will
be used for the purposes related to the Act and Marine Orders and will be treated in accordance with the Australian Privacy Principles. AMSA
may give some or all of this information, including information concerning the validity, cancellation, imposition of restrictions or suspension of
certificates to overseas marine administrators, ship owners, operators, agents, the Australian Communications and Media Authority and law
enforcement agencies as required by law. Failure to provide the information may result in the transaction not being processed.

To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how
information may be used or disclosed,visit AMSA's privacy policy at http://www.amsa.gov.au/privacy/.

Australia Post privacy statement

Australia Post is acting as an agent for the Australian Maritime Safety Authority (AMSA). The information requested on this form is being
collected by Australia Post to determine if you are eligible for the issue of a:

• Certificate of competency or certificate of recognition as a master, deck or engineer officer or GMDSS ROC; or
• Certificate of proficiency, rating or safety training in order to serve as a seafarer.

Your application will not be able to be processed if you do not provide this information. Your personal information is managed in accordance with
Australia Post's privacy policy which is available at auspost.com.au. Australia Post may only disclose the information provided by you if required
or authorised by law, or in accordance with our privacy policy. You may obtain access to your personal information by contacting the Privacy
Contact Officer, Australia Post, GPO Box 1777, Melbourne, VIC 3001.

Declaration and submission

Warning: Giving false or misleading information is a serious criminal offence and may lead to prosecution. Submitting an incomplete or incorrect
application will cause significant delay. Before you submit the form, please review the information entered on this form to ensure it is correct.

• I have completed the checklist, and have confirmed that I have attached all of the documentation that is required by AMSA to process this
application.
• I have reviewed the information entered on this form. To the best of my knowledge, the information given by me in this application is true
and correct in every detail.

Signature Name Date

Ian Tait 22/09/2021

AMSA form 419, Page 7 of 9

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Proof of identity

Proof of identity documents must be presented to Australia Post at the time of lodging your
application. These MUST be original documents. For details of the proof of identity
requirements go to www.amsa.gov.au.

Your photograph will be taken upon lodgement of your application at Australia Post
at no extra cost to you.

Overseas applicants should include photos as per specifications below:

Include two photographs of yourself, taken within the previous six months. Attach one
below and include a second with this application. Both photographs must be certified on
the reverse side and have dimensions of 45 mm x 35 mm (not including a border), as
indicated below.

The certifying officer must state: "This photograph is a true likeness of (your full name)." Photograph to be attached by
and include the date of certification and the full name, signature and title of the certifying Australia Post
officer.

Proof of identity verified by Australia Post

Australia Post officer name Australia Post officer signature Date

--------------------------------------------------------- --------------------------------------------------------- -------------------/--------/------------------

Australia Post location code

--------------------------------------

Specimen signature is required for digital imaging into your AMSA-issued certificate. DO NOT sign until instructed by Australia Post .
Please use a BLACK pen and ensure your signature fits inside the box

To ensure that we have a clear signature for purposes of digital imaging, it may be necessary to obtain a second signature from you.
Please sign the box below if advised by Australia Post, use a BLACK pen and ensure your signature fits inside the box.

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AMSA form 419, Page 9 of 9
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