GENERAL DIRECTORATE OF MERCHANT MARINE
PO Box 5245 Panamá 5, Republic of Panamá
APPLICATION FORM FOR REGISTRATION

THE CURRENT APPLICATION FEE MUST BE SENT WITH THIS APPLICATIONS FORM (THE FEE IS NOT RETURNABLE)

Flag state surveyors should have the followoing professional qualifications, whever posisible:
  • A Certificate issued under the relevant provisions of the STCW Convention, as amended, as:
    - Master, enabling that person to command a ship of 3,000 GT or more; or
    - Chief engineer, enabling the person to command the machinery installed in a ship powered by main propulsion machinery of 3,000 kW or more; or
    - Meet the provisions of the Radio Regulations or hold an appropriate certificate related to GMDSS, or
  • A university degree or diploma as a naval architect, mechanical engineer, electrotechnical engineer, or other type of engineer whose professional education relates to the maritime indrustry; or
  • Not less than fice years service as an officer in board a ship at sea, or in a capacity as naval architect, or as an engineer in the maritime field, or
  • A relevant university degree or diploma, augmented by completion of the IMO model courses: 3.03 Machinery, 3.04 Electrical Installations, 3.05 Fire Appliances and Provisions, 3.06 Life-Saving Appliances, 3.07 Hull, and 3.08 Navigations and relevant sea- service of not less than six months.
  • Application form must be duly fulfilled.
  • Medical examination must be submitted.
  • Copy of passport.
  • In case of renewal, last ten vessels inspected.

    Note: Documents must be duly aunthenticated by panamenian consulate or notary public, in case documents are in different language than english or spanish, also must be duly translated.
1. PERSONAL DETAILS OF APPLICANT
Title (Mr, Mrs, Eng, etc.)
Full names
Nationality
Date of birth
Postcode
E-mail
Tel. No.
Fax. No.
Mobilphone No.
Home address
2. PORT REQUESTED TO CARRY OUT INSPECTIONS
Name of organisation
Address
Postcode
Tel. No.
Fax No.
3. GENERAL EDUCATION
(Final level only, e.g for college / university entrance)
  From To Educational establishment Grade
1.
2.
3.
4.

4. TECHNICAL AND ACADEMIC QUALIFICATIONS

(Supopported by documentary evidence)
  Year Award Course/Subjects Qualify autority
1.
2.
3.
4.
5 MEMBERSHIP OF PROFESIONAL BODIES
(Membership number to be quote)
  Profesional body Date elected
1.
2.
3.
4.
6. REGISTERED TRAINING COURSE DETAILS
  From To Name of organization conducting the trainig Title of course or trainig sheme
1.
2.
3.
4.
7. REGISTER INFORMATION
Plese indicate with a cross sectors which can be supported by your experience
 
All aspects of IMO conversions Safety management system Electrical system
Safety of Navegation MARPOL Annexes Hull and Machinery
Fire Fighting System Oil - water Separators Emergency Procedures
Inert Gas Systems Crude Oil Washing / Tankers Aspects of IMO codes
Life Saving Equipment Cargo Handling Loadline assigments
All aspects of national laws and reg. Bunkering Procedures Bridge navigation and accion

8. PRACTICAL COMMERCIAL EXPERIENCE

(Enter in cronological order with present or most recent experience listed first)
  From month yeard To month yeard Job title Name of organization Title of course or trainig sheme
1.
2.
3.
4.
*Future information can be submitted on an aditional sheet
9. DECLARATION
Apply for ASI inspectors and agree to the publication in a register of all personal details an specifically field of experince.
Certify that the statements contained in this form are corret to the best of my knowledge and beleif.
Signed Applicant:
Date: