Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698942691676.pdf (Saint Kitts and Nevis)
Form A15 ST KITTS & NEVIS INTERNATIONAL SHIP REGISTRY The Saint Christopher & Nevis Merchant Shipping Act Cap.
7.05 Department of Maritime Affairs, Ministry of Tourism and International Transport APPLICATION FOR SEAFARERS DOCUMENTS {STCW Certificate of Endorsement (CoE) attesting the recognition of another Administration’s Certificate and/or Continuous Discharge Certificate (CDC) incorporating Seafarers Identification and Sea Service Record} PLEASE COMPLETE IN CAPITAL LETTERS IN BLACK INK OR BY TYPING AND READ EXPLANATORY NOTES ON PAGE 3 TYPE OF APPLICATION (please tick) Maritime Registrar through which application submitted: Joint Application CDC & Certificate of Endorsement Ship Security Officer Continuous Discharge Certificate Tanker Certificate of Endorsement Renewal/ Replacement GMDSS Other PART A – TO BE COMPLETED BY ALL SEAFARERS 1) Surname: 2) Given name(s): PERSONAL DETAILS OF SEAFARER Home Address of Seafarer: 3) Address Line 1 4) Address Line 2 5) Town/City 7) County/State 9) Tel: Documents will be sent to this address unless the application is made through the Dept.
of Maritime Affairs, the office of a Maritime Registrar or other party (e.g.
Owner, Crew Manager) when they will be sent to that office for passing onto the seafarer 10) Fax: 6) Post/Zip Code 8) Country 11) Email: 12) Passport No: (see Notes on pg 3) 13) SKN Seafarers No: (renew/replace) 14) Date of birth (dd/mm/yy): 15) Place of birth: 16) Nationality: 17) Height cms Weight kg: 18) Colour of hair: 19) Colour of eyes 800 20) Medical Certificate Issue Date: 21) Medical Certificate Expiry Date: 22) Sex (M/F): 23) Distinguishing marks (if any): DETAILS OF NEXT OF KIN OR PERSON WHO CAN BE CONTACTED IN CASE OF AN EMERGENCY 24) Name (Family name, Given name): 25) Relationship (e.g.
Mother, Wife, Friend): 26) Address (If same as seafarer, state “same as above”): 27) Address 28) Town/City 29) County/State 30) Post/Zip Code 31) Country 32) Tel: 33) Fax: 34) Email: FORM CODE: A15 ISSUE No: 006 EFFECTIVE: 13/01/2014 Page 1 of 3 PART B – TO BE COMPLETED BY APPLICANTS REQUIRING A CERTIFICATE OF ENDORSEMENT DESCRIPTION OF HIGHEST GRADE OF CERTIFICATE NOW HELD 35) Capacity: 36) Date of Issue: (dd/mm/yy) 37) Date of Expiry: (dd/mm/yy) Form A15 38) Certificate No: 39) Name of Issuing Authority (Flag State) : GOC (GMDSS) Chemical Tanker Gas Carrier Oil Tanker Ship Security Officer 40) ADDITIONAL ENDORSEMENT REQUESTED (if required, tick box) Other 41) Date of Issue of current endorsement: 42) Date of Expiry of current endorsement: 43) Endorsement No: 44) Name of Issuing Authority (Flag State): 45) Seafarer’s shall receive familiarization and basic training or instruction in accordance with section A-VI/1 of the STCW code.
The following certificate/s must be included with this application evidencing the applicant’s proficiency in the following Emergency, Occupational Safety, Medical Care and Survival Functions.

* Applicant’s proficiency as per regulations VI/1, 1-4 may be evidenced by one certificate covering all functions, or by certificates showing each function separately.
** For candidates for a certificate of proficiency as a ship security officer (please tick in boxes below): [ ] Regulation VI/1-1 Competence in personal survival techniques [ ] Regulation VI/1-4 competence in personal safety and social responsibilities [ ] [ ] Regulation VI/1-2 Competence in fire prevention and fire fighting [ ] Regulation VI/5 - Proficiency for Ship Security Officers ** Regulation VI/1-3 Competence in elementary first aid [ ] Document is now expired or no more room for entries [ ] Document has been lost or damaged (please explain circumstances of loss below) [ ] Requires amending (state amendment below) [ ] Other (please explain in the box below) 46) REASON FOR REPLACEMENT OR RENEWAL Details: 47) PART C – DECLARATION – TO BE COMPLETED BY ALL SEAFARERS I hereby declare that the information contained on this application is true and correct and I apply for the Seafarers documents requested.
If I am applying for a Certificate of Endorsement issued under STCW Convention, Regulation II/2, III/3 OR III/4 or issued under VII/1 at Management Level, I have familiarised myself with St. Kitts & Nevis Maritime Legislation as available on the website www.StKittsNevisRegistry.net .

I am aware that if I submit fraudulent documents, I may be banned from serving on St. Kitts & Nevis ships and liable for prosecution.
Signature of Seafarer Date of Application Please keep your signature within the box and sign without touching any of the box lines FORM CODE: A15 ISSUE No: 006 EFFECTIVE: 13/01/2014 Page 2 of 3 Form A15 Attached (please tick) For Official use PART D – SUPPORTING DOCUMENTS REQUIRED WITH APPLICATION SUPPORTING DOCUMENTS REQUIRED (all applications): Copy of passport – showing personal details of Applicant as per those entered on this Application Form 2 x Passport size photos - with applicants name printed on the reverse Valid Medical Fitness Certificate (the medical examination must be carried out no more than 18 months before this application) CDC Only : Copies of training certificates (as outlined in 45), above) Payment or Proof of payment of Fees Any other documentation SKANReg may deem necessary for this application (if requested) Certificate of Proficiency for Security Awareness Training (VI/5) or Security Training for Seafarers with Designated Security Duties (VI/6) In addition - for Continuous Discharge Certificate (CDC) 7 Current CDC (if requesting renewal/replacement) In addition - for Certificate of Endorsement (CoE) 8 9 10 11 Copy of current Certificate of Competency (COC) from the home country of the applicant or a country listed in the "White List" of the IMO.
Copy of current additional Endorsement (GMDSS, Tanker, Ship Security Officer etc) (if applying for this) Proof of Sea Service – copy of sea service certificates or pages from seaman’s book showing personal details and ranks served Current CoE (if applying for extension) EXPLANATORY NOTES FOR APPLICANTS: 1) All information must be printed in CAPITAL LETTERS in black ink or by typing.
2) Failure to complete the Application Form fully or submit the required documentation may result in rejection or delays in processing.

3) Applicants must sign in the box shown, keeping their signature within the box lines.

4) Item (12) – Passport – This must be a National Passport.

If a National Identity Card or Seaman’s Passport is submitted, this must be recognised by the issuing authority as a travel document i.e.

can be used in lieu of a National Passport.


5) Applicants may initially submit their application by scanning the Application Form and supporting documents and submitting by email to mail@StKittsNevisRegistry.net.

The original can be forwarded by mail/courier.

6) All supporting documents submitted must be clear copies and legible.

If supporting documents are not clear and legible then the application will be returned.
7) For an up to date status on the IMO “Whitelist” see www.imo.org 8) Endorsements issued by SKANReg will have the same expiry date as the Certificate whose recognition they attest, up to a maximum of 5 years.

9) Applicants for Endorsements, must be in possession of, or have applied for, a St.Kitts & Nevis CDC.

10) Application Fees will NOT be returned if incorrect information or documentation is submitted or verification cannot be obtained.
11) For more information see the website www.StKittsNevisRegistry.net 12) CDC only applications MUST have basic training certificate/s attached.

Applying for Seafarer Documents?

Do you have the following?

Application form for CDC, CoE or Additional Endorsement Need a CDC?

CDC Passport, Valid Medical certificate, Basic Training Certificates Photo’s x 2 Already hold a SKANreg CDC?
Other Endorsement SKN number Copy of GMDSS, SSO, Tanker or other additional endorsement COE Copy of current CoC from home country or from a country listed in the “White List” of the IMO FORM CODE: A15 ISSUE No: 006 EFFECTIVE: 13/01/2014 Page 3 of 3