11. LIST ALL REPUBLIC OF THE MARSHALL ISLANDS (RMI) DOCUMENTS
RMI CERTIFICATE NO.:
12. PLEASE INDICATE HERE THE SPECIAL QUALIFICATIONS DESIRED:
TOTAL SQCs REQUESTED:
13. I HEREBY AFFIRM THAT ALL INFORMATION PROVIDED BY ME IN THIS APPLICATION AND ITS SUPPORTING DOCUMENTS AND PROOFS IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF; FURTHER, THAT NO LICENSE, CERTIFICATE OR DOCUMENT ISSUED TO ME HERETOFORE BY ANY GOVERNMENT HAS EVER BEEN REVOKED OR SUSPENDED, OR, IF REVOKED OR SUSPENDED, A FULL EXPLANATION OF THE CIRCUMSTANCES IS ATTACHED HERETO AND MADE A PART OF THIS APPLICATION.
Application (MI-273) completed and signed by applicant.
One (1) 1¾” x 1¾” (45mm x 45mm) photo showing facial front view attached.
Acceptable proof of identification submitted. Copy attached. Certified translation provided if identity document is not in English.
Proof of STCW Basic Training.
Proof of Security Awareness qualifications.
Copy of physical exam submitted.
Letter of commitment for assignment to an RMI flagged vessel (for Seafarer's Identification and Record Book (SIRB) initial applications only).
Requisite fee included.
SIGNATURE OF FILING AGENT
FILING AGENT’S TITLE
FILING AGENT'S COMPANY
14. SEA SERVICE - List and submit proof of at least the minimum service required to establish eligibility for the special qualification rating requested. (See Part 7.0 of publication MI-118). Proof can be established by a photocopy of the seafarer's own national discharge book or RMI SIRB. If the Officer Certificate of Competence Application by Endorsement (MI-105) is being submitted with this form, the section on sea service may be completed on the MI-105 or a transcript/certified record of sea service may be attached in lieu of completing the section below.
1. Age, experience, educational and medical requirements for “Seafarer Identification and Record Book” and “Special Qualification Certificates” are detailed in "Requirements for Seafarer Certification," publication
MI-118, which is available on board every RMI registered vessel.
2. Please enclose payment with each application: new SIRB=US$60; SQC=$US35 (no fee required for Basic Training, Wiper, Junior Ordinary Seafarer, GP Trainee, General Steward Utility)
3. Payment must be made by check or money order drawn on a bank or branch in the US and payable in US Dollars to "THE TRUST COMPANY OF THE MARSHALL ISLANDS, INC." Fees may also be paid online by credit card.
4. Applications must be sent to:
c/o MARSHALL ISLANDS MARITIME AND CORPORATE ADMINISTRATORS, INC.
or, to any of the Regional Offices named in RMI Marine Notice No. 1-002-1.
5. All applicants for certification of a Special Qualification must hold an RMI Seafarer's Identification and Record Book or apply at the same time for this book. (See Section 5.0 of publication MI-118).
6. Applicants for Special Qualification Certificates holding and/or renewing an RMI Seafarer's Identification and Record Book must submit a copy of Page 2 of that book.
Applicants should keep a photocopy of this completed application as evidence that an RMI Certificate is pending or, for those Filing Agents authorized by the Maritime Administrator to submit orders through the online application system, an Acknowledgement of Application for each SIRB or SQC (MI-273OR) will be generated and, in lieu of the copy of the application, the MI-273OR shall be retained by the seafarer as evidence that the application is being processed. The application or MI-273OR shall be valid for up to 90 days as proof of authorization to serve on an RMI flagged vessel in the capacity for which the seafarer has applied.