Oil Chemical Gas

Application for endorsement.
Tankerman Highest Grade.
Personal information
Date of birth
Surname
First and middle name
Permanent address
City
Country
Citizenship
The application is subject to a fee, which must be paid in full before the application can be processed.
The invoice and reply to the application will be sent to the company’s address.
Oil
☐
Chemical
☐
Gas
☐
Documentation
Requirement
Certificate of
Proficiency
- option 1
Certificate of
Proficiency
- option 2
Photo
Description
Tankerman Certificate Highest Grade which complies with the STCW
Convention regulation V/1.2 or table A-V/1 8 -14 for oil, A-V/1 15-21 for
chemical, A-V/1 22-34 for gas.
Tankerman Certificate Highest Grade which complies with the STCW 78
Convention (including 2010 Manila amendments) regulation V/1-1.3 for
oil, V/1-1.5 for chemical, V/1-2.3 for gas.
Passport photo
Att. No.
Company and applicant information
Company’s name
Company’s address in Norway
Street, City
Company’s telephone number
Company’s e-mail
Name of ship and call sign
Applicant’s position on board
I hereby certify that all information given by me in this application and the attached
documentation is true and correct to the best of my knowledge.
Date of application:
Applicant’s signature:
Company’s representative signature and seal:
KS-0377-24 – FS/USB
Rev. 2015-04
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Norwegian Maritime Authority
Application for endorsement.
Send the application to the following address:
The Norwegian Maritime Authority
P.O. Box 2222
N-5509 Haugesund
NORWAY
KS-0377-24 – FS/USB
Rev. 2015-04
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