AMTC · Candidate services

Seafarer Assessment

Complete your COC assessment form, attach your documents and download a reference copy.

AMTC BANGKOK

ALEX MARITIME & TECHNICAL COLLEGE BANGKOK

THAILAND | INDIA | MALAYSIA | EGYPT

Under AlexArya

SEAFARER'S ASSESSMENT CUM APPLICATION FORM FOR COC

(F-13/01)

Fields marked * are required for submission. You can download a draft at any time. Keep this tab open to retain your entries and selected files.

01 Seaman particulars

Name of the seaman *

Rank Applied for *

Date of Birth *

Nationality *

Seaman ID Book No *

Issued by *

Issued on *

Passport No. *

Expires on *

Full Address *

Contact No *

Email Id *

02 Other License in Possession with:

Fill the rows that apply to you. Leave unused rows blank. Swipe horizontally on smaller screens.

Other licenses
Sl.No.	License/COC	Date of Issue	Place of Issue	Remarks
1
2
3
4
5
6

03 Last 05 years Sea Experience:

Fill the rows that apply to you. Leave unused rows blank. Swipe horizontally on smaller screens.

Sea experience
Name of Vessel	Grade	GRT/NRT	From	To	Total no. of Months/Days

04 Candidate declaration

I acknowledge that the information mentioned above are true & best to my knowledge and belief. If documents found false or manipulated then my documents will be cancelled and no fee will be refunded.

Name & Signature of Candidate — Name *

Sign. — Type your full name *

Date *

Signature image (optional)JPG or PNG, up to 10 MB. Included in the PDF.

Attach the following Documents on email

Select all five document types below. Files are sent with your form when you press Submit. For email submission, attach the original files separately to your downloaded form.

01International Passport Copy*

PDF, JPG or PNG · Up to 5 files · 10 MB per file · 25 MB per group

02Current Certificate Of competency*

PDF, JPG or PNG · Up to 5 files · 10 MB per file · 25 MB per group

03Passports Size Photo*

JPG or PNG · Up to 5 files · 10 MB per file · 25 MB per group

04Valid STCW Certificate*

PDF, JPG or PNG · Up to 5 files · 10 MB per file · 25 MB per group

05Seaman Book Page Showing Sea Experience*

PDF, JPG or PNG · Up to 5 files · 10 MB per file · 25 MB per group

FOR OFFICIAL USE ONLY

Remark of Assessment Officer:

Name:

Sign.: Date:

Office seal

Reserved for the assessment officer. Candidates do not fill this section.

180/23, Sai Lourd Road, T.Paknum, A.Muang, Samutprakan-10270 Thailand

E-mail: training@amtcmarine.com | Website: www.alexarya.org

Rev.21/04-06

Your copy, ready to keep.

Download your entries in the original PDF format, or download a blank editable copy to fill offline and email with your documents to training@amtcmarine.com.

Download Blank PDFOffline Template