HONG KONG MARINE DEPARTMENT
香 港 海 事 處
Consolidated Application for the Issue of Hong Kong Licences
申 領 香 港 執 照 綜 合 名 單	   	

To :	Marine Department,	Attention :	Senior Surveyor / Seafarers’ Certification
	Government of HKSAR	Fax : (852) 2541 6754

From: _________________________________________________________________________ (Company Name)

Address : 	

Contact Person:                                             E-mail :

Tel. : 	Fax : 	Date : 

We submit herewith applications with the required documents for Hong Kong Licences in respect of the following officers for serving on board Hong Kong registered ships :

No.	
Name	
Rank	
Certificates No. &
Country of Issuing
Authority	
Dangerous Cargo
Endorsement held
(oil/chemical/liquefied gas)	
GMDSS GOC No.
& Country of Issuing Authority 	

						

	

	

	

	

	

	

	

	

						

Official Acknowledgement 		(File Ref.: SD/CRT 857/7)

This receipt serves as a documentary proof in accordance with paragraph 5 of the STCW Regulation I/10 to certify that the above named applicants have applied to this Administration for the issue of Hong Kong licences in order for them to work on a Hong Kong registered ship while the applications are being processed See Note 1. The officers shown above are allowed under the STCW Regulation I/10 paragraph 5 to serve on a Hong Kong registered ship at the rank as indicated above or at a lower rank for a period not exceeding three months pending the issue of Hong Kong Licences by this Administration. 
Please contact the Senior Surveyor of Seafarers’ Certification Section (telephone no.: +852 2852 4368, fax number: +852 2541 6754 or email address: sscrt@mardep.gov.hk) regarding any enquiries of this receipt.

Signature of Issuing Authority :	Stamp of Issuing Authority :	

                           for Director of Marine

Note 1:  For the information of Port State Control Officers, please note that the STCW Convention does not require the original copy of this receipt to be carried on board.  
M.O. 713A (rev. 7/2011)