Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697630842701.pdf (Antigua and Barbuda)
GOVERNMENT OF ANTIGUA AND BARBUDA DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING (ADOMS) Check List Document Revision Page FO-C14 06 1 of 1 Reference ARP-C01 1.

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Date of Birth Note: Please attach the completed checklist to the Application FO-C01 *Application for: STCW Endorsement  Seafarer's Book  *Items to be checked (* where applicable) Check1 Check2 Yes No Yes No Remarks General 1 Application signed and dated by applicant/filing agent/crewing company/owner .1 Each document is copied on one page (size A4) .2 Documents are in English language or certified translation is attached .3 1 Photograph, passport size, recently taken (preferably in color) .4 Items 1-11 completed (FO-C01 Part I) .5 Name/Surname checked for correctness .6 Name is spelled according to the spelling in the passport .7 Details of Antigua and Barbuda endorsement (if available FO-C01 Part II) .8 .9 Description of national certificate (if available) .10 Details of watch keeping endorsement (if available) .11 Certificates issued by a country stated on the IMO list .12 Requirement(s) marked correctly in A; B; C; D; E; F (FO-C01 Part III) .13 .14 Schools attended completed (for officers only, FO-C01 Part VI) .15 Check of ADOMS online database to avoid duplication (only by filing agent Check 1) .16 Confirmation that seafarer has adequate communication skill in the English language 2 .1 .2 Application for the issuance of a Seafarer's Book Copy of passport Valid medical certificate issued by an approved medical practitioner in accordance with Reg.
I/9 of STCW 1978, as amended Proof of sea service (minimum of 6 months) or Basic Safety Training Certificate Confirmation that applicant will serve on a vessel under A&B flag (FO-C01, Part III, N° 14: name/owner of vessel on which now serving or will join) Items 16 and 17 completed (FO-C01 Part IV) .3 .4 .5 3 .1 .2 .3 .4 .5 .6 .7 4 .1 Application for the issuance of a STCW Endorsement (in addition to all documents stated under 2) National Certificate of Competency/endorsement, authenticity and validity confirmed by the issuing administration which is Party to the STCW Convention Sea service (minimum of 1 year during the last 5 years), proof available and checked   Part V of Form FO-C01 or Printout of sea service records Alternatively, proof of participation in an adequate refresher course Qualification of applicant sufficient for the endorsement applied for Declaration of familiarization (FO-C13) (management level only) Application for the issuance of a GMDSS Endorsement (in addition to all documents stated under 2) National GMDSS certificate, authenticity confirmed by the issuing administration which is Party to the STCW Convention Check No.
1 Conducted by Name (in print) Place Date Result*++ positive negative Initial Filing Agent 2 ADOMS Oldenburg Certificate of Receipt of Application (CRA) CRA No.

Date sent by e-mail sent by fax Initial * please tick  where applicable ++ If verification result is negative complete Form FO-C09 "Rejection of Application" and inform applicant; If verification result is positive, proceed processing of application.

14.11.12 FO_C14_Checkl_verifi_applic.doc