Candidate Services · Form F-13/01

Seafarer Assessment Cum Application Form

Complete your formal assessment for Certificate of Competency (COC), attach relevant documentation, and download or submit your file.

Hanoi OffshoreTraining Centre

Hanoi Offshore Training Centre

& Technical College · Maritime Affairs Dept

Parent Organisation: Mekong Marine

F-13/01

Rev. 21/04-06

Seaman Particulars

Name of the seaman

Rank Applied for

Date of Birth

Select date (YYYY-MM-DD)

Nationality

Seaman ID Book No

Issued by

Issued on

Select date (YYYY-MM-DD)

Passport No.

Passport Expires on

Select date (YYYY-MM-DD)

Full Residential Address

Contact Phone No

Email Address

Other License in Possession with:

List up to 6 professional maritime licenses, previous COCs, and issuing authorities.

#	License / COC	Date of Issue	Place of Issue	Remarks
1		Issue Date
2		Issue Date
3		Issue Date
4		Issue Date
5		Issue Date
6		Issue Date

Last 05 Years Sea Experience:

Enter your verified sea service records chronologically (up to 16 rows accommodated on official form).

#	From	To
1	From Date	To Date
2	From Date	To Date
3	From Date	To Date
4	From Date	To Date
5	From Date	To Date
6	From Date	To Date
7	From Date	To Date
8	From Date	To Date
9	From Date	To Date
10	From Date	To Date
11	From Date	To Date
12	From Date	To Date
13	From Date	To Date
14	From Date	To Date
15	From Date	To Date
16	From Date	To Date

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.

Candidate Legal Name

Typed Signature

Signature Date

2026-11-08

Attach Signature Image (Optional PNG/JPG to embed in PDF)

Document Attachments

Select or download your verification documents (PDF, JPG or PNG up to 10MB each).

International Passport Copy

No file attached

Browse

Current Certificate of Competency (COC)

No file attached

Browse

Passport Size Photograph (JPG/PNG)

No file attached

Browse

Valid STCW Modular Certificates

No file attached

Browse

Seaman Book Pages Showing Sea Experience

No file attached

Browse

For Official Use Only (Assessment Officer & Registry)

Remark of Assessment Officer: ___________________

Name & Rank: ___________________

Signature & Date: ___________________

Download Blank PDF Template

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License / COC

Date of Issue

Place of Issue

Remarks

Issue Date

Name of Vessel

Grade / Rank

GRT / NRT

From

Months / Days

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

To Date

From Date

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From Date

To Date