MSF 4364/REV 03/20

APPLICATION FOR A BOATMASTERS’ LICENCE

New Entrants
BML
IMPORTANT - BEFORE completing this form, please ensure you have read the guidance notes and
instructions on pages 13 to 16. Please provide an email address in block capitals in order for us to inform
you of the receipt of your application (see section 14 of the guidance notes).

1. PERSONAL DETAILS
Title Mr/Mrs/Miss/Capt etc Sex: Male/Female

Surname /Family name

Forename(s) in full
Date of Birth
Place of Birth Country of Birth
Nationality

Full home address Address for return of documents

(if different from home address)
Street/Road

District

Town/City

County/State

Post Code/Zip

Country

Telephone No

Mobile No Email

2. CERTIFICATE APPLIED FOR

Tier Level Please tick one box
UK Boatmasters’ Licence – Tier 1 Level 1
(National) Level 2
UK Boatmasters’ Licence – Tier 2 Level 1
(Specified Areas) Level 2
Please do not write below this line

Received: Fee: BML ID

Receipt No
BML No

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3. ANCILLARY SAFETY TRAINING - All Applicants

Boatmasters’ Licence applicants are required to have undergone MCA approved basic safety training in
Personal Survival, Fire Safety and First Aid or completed the relevant Maritime Studies Qualification Units in lieu of
this training. Please include original certificates with your application.

Course or Training Certificate enclosed Validated (MCA use ONLY)

Please tick (✓)

4. UNDERPINNING KNOWLEDGE - Tier 1 Applicants Only

Those Tier 1 applicants with an underpinning knowledge examination pass certificate or relevant Maritime Studies
Qualification Unit completion certificate should enclose the certifcate with their application.

Course or Training Course Provider Validated (MCA use ONLY

Level 1

Level 2

5. SPECIALIST OPERATIONS ENDORSEMENTS - Tier 1 Applicants Only

Please indicate below if you are applying for an endorsement, for further information please refer to section 4 of the
guidance.

Specialist Endorsements Please tick (✓) as appropriate

General Passenger Operations

Large Passenger Vessel (more than 250 passengers)

General Cargo

Oil Cargo

Chemical Cargo

Gas Cargo

Dredging

Towing and Pushing

Fast Craft

Radar

Ro-Ro Operations(Tidal waters)

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6. LOCAL KNOWLEDGE ENDORSEMENTS - Tier 1 Applicants Only
A Tier 1 licence is valid for all UK waters of the relevant Catergories other than those specified as requiring a local
knowledge endorsement. Please see section 6 of the guidance for a list of areas which require local knowledge
endorsements. Please indicate which areas you are applying for below:

Name(s) of Area(s)

7. SPECIFIED AREA(S) AND OPERATION(S) - Tier 2 Applicants Only

A Tier 2 Licence is valid for operations within specified areas. In the box below please indicate:

Area(s) of Operation Passenger operations Non - passenger operations

(please tick)
Y/N Max no of GC* OC* TP* DR* WB* other
passenger
s

*Please see section 7 of the guidance on compleing this table.

If you have ticked other please clarify below:

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

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8. EXAMINATION AVAILABILITY - All Applicants

Please indicate your availability in the box below:

Please arrange my underpinning knowledge/boat handling test as soon as possible after……………(Date)

I am not available on the following dates……………………………………………….

9. MEDICAL FITNESS - All Applicants

All applicants must submit a valid medical fitness certificate appropriate to the type and area of operation with their
application. Further guidance on medical fitness is available in Section 16 of MSN 1853.

Medical Evidence enclosed Please tick

(✓ )
ML5 report and certificate*
ENG1 Seafarer Medical Certificate

* If the doctor has been unable to complete the certificate because a medical condition is indicated, you should
complete Part D of the ML5 form and send it with this application for medical assessment.

Caution: It is your responsibility to declare any medical conditions, or any changes to your health, that
are likely to affect your performance and safety as a Boatmaster.

10. IDENTITY DOCUMENTS - All Applicants

Please enclose your passport or photo driver's licence. It will be returned to you with your licence. If you do not
have either, another document that contains a photo of you may be considered. If you do not have any form of
photo identification, please contact your local Marine Office.

Enclosed Checked
Document (MCA use ONLY)
(please tick)
(✓ )

Passport
Or Photo Driver's Licence
Or Other (see above)
And Two passport-size (50 by 40 mm) photos
- taken full face without hat
- endorsed*, as a good likeness

*The back of one photograph must include your name in BLOCK LETTERS, and the signature of a Doctor, Bank
Office, Established Civil Servant, School Teacher or someone of similar standing.

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 11. DETAILS OF SERVICE - All Applicants 3.

From (date) To (date)

Category/ies of Water and No. of days
Vessel’s Name Rank/Capacity Type/Class Name of Owner
Operational Area(s) worked
dd/mm/yyyy dd/mm/yyyy

Note:
Qualifying Service Time (QST) must be within the past five years.
Please see section 9 for further information on QST requirements.
Self-certification of service is not acceptable.

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12. DECLARATION (The maximum penalty for a false declaration is £5000)

Data sharing

Data contained in this application may be shared with other statutory bodies or organisations to enable them to
meet their statutory obligations and to inform statistics for research or statutory purposes. The data shared is
limited to the applicant’s name, licence number, licence expiry date and any local or specialist operations
endorsements held.

I declare that the data contained in this application is, to the best of my knowledge, true and complete. I also
declare that the documents are genuine, given and signed by the persons whose names appear on them. I consent
to any processing of the data contained in this application by the MCA (including any processing necessary to
establish the authenticity and validity of the issued certificate) and to the sharing of data in accordance with the
previous paragraph. Please refer to our privacy statement in Section 2 of the guidance notes which explains how
we use the personal information we collect from you.

Please sign this form in the centre of the

Space opposite, in BLACK BALL POINT
PEN, this will be transferred to your new
licence.

IMPORTANT – KEEP WITHIN THE BORDER

FAILURE TO COMPLY WITH THIS INSTRUCTION WILL
INVALIDATE THE APPLICATION
FOR OFFICIAL USE
ONLY

Date……………………………………………….

13. COUNTERSIGNATURE

Name

Address

Town / City

County/State

Post Code/Zip Country

Telephone No Occupation

Capacity in which you know the applicant

I declare that the information given is, to the best of my knowledge, true and complete. I also declare that the
documents submitted are, to the best of my knowledge, genuine and relate to the person(s) whose names appear
on them. I confirm that the photographs submitted bear a true current likeness of the applicant.

Signed…………………………………………………………………..…Date……………………………………
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14. CHECKLIST - All Applicants

Please make sure you have enclosed the relevant original items from the list below.
Please Official
tick (✓) use only
Passport or Drivers Licence

Two passport photographs (please refer to section 13 of the guidance)

Ancillary Safety Training certificates/Maritime Studies Qualifications units

Underpinning Knowledge pass certificate/Maritime Studies Qualifications units (if applicable)

Acceptable equivalent certificate for specialist operations endorsement (if applicable)

Pilotage Exemption Certificate or relevant competent harbour authority letter (if applicable)

Work Record (MSF 4366)

Qualifying Service Time testimonials

Training Record Book (MSF 4367)

Valid Medical Fitness certificate (please refer to section 8 of the guidance)

Fee

Please note that a licence cannot be issued until all relevant documents have been received and approved,
together with the correct fee.

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15. MCA MARINE OFFICE CHECKLIST - Official Use Only

Tier 1 Licence

Standards Met Yes No Date

Generic Competencies – On-board Practical Assessment
Generic Competencies – On-board Oral Assessment
Work record (Evidence of QST)
Training Record Book (Completed satisfactorily)
Underpinning knowledge (Training validated)
Specialist Endorsement(s):
General Passenger Operations
Large Passenger Vessel
General Cargo
Oil Cargo
Chemical Cargo
Liquified Gas Cargo
Dredging
Towing and Pushing
Ro-Ro (Tidal Waters)
Fast Craft
Radar
Local Knowledge Endorsement/s: (enter area/s below)

Medical Standards

Tier 2 Licence

Standards Met Yes No Date

On-board Practical Assessment
On-board Oral Assessment
Sufficient Service
Relevant items in Training Record Book (Completed satisfactorily)
Work Record (Evidence of QST)
Medical Standards

Reasons for Rejection

Name Signed Date

TBML No: Date Type Name &Signature

PRINT NAME

SIGNATURE

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MO OFFICE ACTION
TO BE COMPLETED BY MO ADMIN

Action Taken Date Signature

Temporary Boatmaster file opened

Relevant certificates present & validated

ML5 form referred to Medical Assesor

ML5 form returned from Medical Assesor

Original documents returned

QUALIFYING CONDITIONS MET DATE:

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16. INSTRUCTIONS TO RSS - Official Use Only
TO BE COMPLETED BY MCA EXAMINER

Please issue the following licence:

TIER 1

Please tick (✓ )

TIER 1 LEVEL 1 TIER 1 LEVEL 2

Details of Operating Restrictions or Restricted Validity

(Please indicate below)

Specialist Operations Endorsements

Please tick (✓ )

General Passenger Operations Liquified Gas Cargo

Large Passenger Vessel Dredging

Towing and Pushing Fast Craft

General Cargo Radar

Oil Cargo Ro-Ro Operations

Chemical Cargo

Local Knowledge Endorsements

Please tick (✓ )

Bristol Port Padstow Harbour

Caernafon and Menai Strait Port of Liverpool

Dee Conservancy Port of London (Thames Watermen)

Dover Harbour Portsmouth Harbour

Fowey Harbour Isles of Scilly

Gloucester Harbour Teignmouth

Medway

Please specify area of operations for Port of London (Thames Watermen) LKE here:

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TIER 2

Please tick (✓ )

TIER 2 LEVEL 1 TIER 2 LEVEL 2

Details of Specified Area and Operations

(Please inidcate below)

CATEGORY AND AREA DESCRIPTION AND TYPE OF OPERATION

AREA NAME LIMITS (Indicate whether set area AND SPECIFIC
from MSN 1837, or other bespoke RESTRICTIONS
area)

Details of Operating Restrictions or Restricted Validity

(Please indicate below)

17. FEE - Official Use Only

MO to indicate any outstanding fee to be collected by RSS here:

RSS OFFICE ACTION - Official Use Only

Action Taken Date Signature

Outstanding fee received

Details logged on Database

TBML No logged/Copy to file

File sent to store

BML No:

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18. PAYMENT - All Applicants

You must ensure you pay the appropriate fee (as laid down in the current Merchant Shipping Fees Regulations).

To confirm the fee for the licence you require please contact your local MCA Marine Office. Information on
Boatmasters’ Licence fees can be obtained from www.gov.uk. Search for “Boatmaster”.

Payment should be made in pounds sterling (£) by BACS transfer or credit/debit card via online payment facility Gov.uk Pay
by following the links below.

We are unable to accept cheques, postal orders, banker’s drafts or cash.

Please tick (✓) the appropriate box below to indicate your chosen method of payment.

To pay via Gov.UK for North (Aberdeen, Belfast, Glasgow, Hull, Liverpool, Tyne, Stability Unit) 
https://www.gov.uk/payments/survey-and-inspection-north/application-for-boatmasters-license

To pay via Gov.UK for South (Cardiff, Colchester, Dover, Falmouth, Plymouth, Southampton) 
https://www.gov.uk/payments/survey-and-inspection-south/application-for-boatmasters-licence

If you wish to pay by BACS transfer, please email seafarer.finance@mcga.gov.uk 

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GUIDANCE NOTES FOR THE COMPLETION OF THIS APPLICATION FORM

PLEASE ENSURE THAT YOU READ AND UNDERSTAND MSN 1853 BEFORE COMPLETING THIS FORM.
THESE NOTES SUMMARISE THE REQUIREMENTS.

ENSURE YOU COMPLETE THIS FORM IN FULL - FAILURE TO DO SO MAY MEAN WE WILL HAVE TO
RETURN YOUR APPLICATION TO YOU, AND WILL RESULT IN A DELAY TO YOUR APPLICATION BEING
PROCESSED.

WE ARE UNABLE TO ACCEPT APPLICATIONS BY FAX OR EMAIL

Please complete this form in BLOCK LETTERS and in black ink.

1. PERSONAL DETAILS

Enter your personal details in the boxes provided. Your name should be given IN FULL, and should be given in the
same format as appears in your passport or driving licence.

Your date of birth should be given in the format DD/MM/YYYY, e.g. 18 February 1960 should be written 18/02/1960.

You should give your permanent home address, where you are normally resident. You may also provide an
alternative address for return of documents or correspondence relating to this application,.

Your documents will be returned by Recorded Delivery and will need to be signed for. Please ensure you provide us
with the full address details you would like your documents sent to. You must include a contact telephone number
and email address should there be any queries with your delivery.

2. PRIVACY STATEMENT
Personal information which you supply to us will be used to process your application to meet the applicable
Standards of Training Certification and Watchkeeping (STCW) requirements. To check and report on how effective
the MCA and the services it commissions have been. To make sure that the MCA gives value for money. We may
use your information to investigate complaints, legal claims or important incidents. We may use your information for
crime prevention and prosecution of offenders.
The information you provide is primarily used for issuing your UK Certificate of Competency (CoC)/Certificate of Equivalent
Competency (CEC) but may also be used for other related purposes, and shared with other statutory bodies/organisations to
enable them to fulfil their statutory obligations.

We will not disclose any financial details you provide to us. Once your payment has been processed all financial
details are securely destroyed.

For more information on how we use your information, and your rights to access information we hold on you,
please see our full privacy policy available on our website:

https://www.gov.uk/government/organisations/maritime-and-coastguard-agency

3. CERTIFICATE APPLIED FOR

Please tick (✓ ) the tier / level for which you are applying. Only tick ONE box.

4. ANCILLARY SAFETY TRAINING

Ancillary safety training must have been completed at an MCA approved provider. Further details on approved
providers are available from stc.courses@mcga.gov.uk

5. APPLYING FOR A TIER 1 LICENCE SPECIALIST ENDORSEMENTS

Please tick (✓ ) the specialist endorsement for which you are applying. Please see MSN 1853 for further guidance.

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6. APPLYING FOR A TIER 1 LICENCE LOCAL KNOWLEDGE ENDORSEMENTS

Local Knowledge Requirements for areas where a Local Knowledge Endorsement is necessary. Please see MSN
1853 Section 7 and Annex 5 and 13 for further clarification.

Bristol Port – The River Avon from Ashton Swing Bridge to the mouth of the Avon and King Road from Potishead
Point to the port limits to the North and West.

Caernafon and Menai Strait – From the Southern Limit specified in the Menai Strait Pilotage District Pilotage
Directions, that is an imaginary line joining positions 5309.6’N 00425.7’W (Malltraeth Bay); 5305.0’N 00432.15’W
(Caernafon Bay) and 5300.55’N 00423.58’W (afon Hen, Clynnog) to a line drawn between Bangor Pier and Garth-
y-Don.

Dee Conservancy – From an imaginary straight line connecting Point of Ayr (National Grid reference point SJ
12268519) and Hilbre Point (National Grid reference point SJ 20298843) to the Weir at Chester (Tidal Waters
Limit).

Dover Harbour – The harbour and the sea within a distance of one mile from the seaward limits to the harbour.

Fowey – The upper estuary, north of Upper Carne Point.

Gloucester Harbour – The Severn estuary from the harbour limits at Goldcliff to the weirs at Maisemore, Lanthony
(Gloucester) on the tidal River Severn.

Medway - The waters within a line from Garrison Point to Grain Tower thence west to shore-line and from the east
limits of the Port of Sheerness to Rochester Bridge including the Swale as far as Shellness.

Port of Liverpool – The River Mersey from a straight line drawn between the Perch Rock Lighthouse and
Gladstone River Entrance West Bullnose, south to a straight line drawn between the East Bullnose of Eastham 50’
Lock and the West Bullnose of Stalbridge (Garston) Lock.

Port of London (Thames Watermen)* – The River Thames from Putney Bridge to Margaretness.

Padstow Harbour – The waters within a line joining Stepper Point, Gulland Rock and Pentire Point.

Portsmouth Harbour – The waters between No. 4 Bar Buoy and a line drawn from No. 98 Pile to Whale Island.

Isles of Scilly – The waters within a line drawn from Bishop Rock Lighthouse to Scilly Rock, Round Island, White
Island, Hanjague and around the South East of St. Mary’s.

Teignmouth – All waters east of a line joining Ness Point to Den Lighthouse.

*Three individual endorsements are now available for the Port of London LKE Area. Applicants should refer to
Section 7 of MSN 1853 for further guidance.

7. APPLYING FOR A TIER 2 LICENCE

The following table can be used to describe the type of operations:.

GC General Cargoes ( including packaged dangerous goods)

Oil Cargoes (including gas and liquid
OC
chemicals in bulk)
TP Towing and/or pushing
DR Dredging
WB Workboat

Granting of additional areas on a Tier 2 licence is subject to MCA discretion, and will be limited to an adjacent area
or an extension of existing operations. The addition of a completely different area or to accumulate a large number
of areas is not permitted. Candidates wishing to increase scope substantially must obtain a Tier 1 licence.
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8. MEDICAL FITNESS
All applicants must hold a valid ML5, ENG1 or acceptable alternative medical fitness certificate when they apply for
a licence.

If you need to obtain a new ML5 certificate, please ensure you are using the latest version of the form. This can be
obtained from your local Marine Office or downloaded from www.gov.uk . Search for “MSF 4112”.

ENG1 certificates are issued following an examination by an MCA approved doctor. A list of MCA approved doctors
is available from www.gov.uk . Search for “MCA Approved Doctor”.

9. DETAILS OF SERVICE
Before you submit your application it is important that your check the Qualifying Service Time requirements in MSN
1853. MSN 1853 is available from www.gov.uk. Search “MSN 1853”.

Testimonials must support the information contained in Section 11 of the application form. The following are
accepted forms of evidence for service:

1. A company letter signed by an appropriate person (e.g. the owner or fleet manager);
2. A letter from a representative of the statutory navigation/port authority responsible for the area in which the
applicant operates;
3. A letter from a shipper or customer who can verify the applicant has the relevant experience; or
4. A letter from a trade association who can verify the applicant has the relevant experience.

The template testimonial on page 17 can be used for testimonials for examples 2-4.

10. DECLARATION
Please read the declaration. Once you are sure that the information you have given is, to the best of your knowledge,
true and complete, and that the documents submitted are genuine, given and signed by the persons whose names
appear on them, you should sign the declaration with your usual signature, including the date. Ensure your signature is
inside the box – this will be transferred to your licence.

11. COUNTERSIGNATURE
You should obtain a counter signature from a responsible person who is NOT related to you and has known you for
at least 2 years. They should enter their details in this section. This person must endorse the rear of one of your
passport style photographs "I confirm that this is a true current likeness of [your name] and their usual signature
and date. See also see Section 13 of the guidance notes on photographs.

12. PAYMENT

You must enclose the correct fee with your application. Please tick (✓) the appropriate box to indicate your chosen
method of payment.

Payment must be made in pounds sterling (£). Payment by cheque, banker’s draft or postal orders should be made
payable to "The Maritime and Coastguard Agency" and crossed "account payee" and "not negotiable".

For payment by Maestro, Visa, MasterCard or Delta, ensure you enter the card details in the spaces provided. Please
sign to confirm the amount and chosen method of payment.

To confirm the fee for the licence you require please contact your local MCA Marine Office. Information on
Boatmasters’ Licence fees can be obtained from www.gov.uk. Search for “Boatmaster”

13. CHECKLIST

ALL the documents in this section MUST be provided with this application, before an exam can be taken. Please
ensure you tick (✓ ) each box to indicate that you have enclosed the documents.The supporting documents must be
original. Any candidate failing to submit all the required documents may have their application returned without being
processed.
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Photographs

Your photographs must be taken full face without a hat and must be UK approved passport photographs, measuring a
maximum of 50mm x 40mm, in colour with a plain white background. The back of one photograph must include your
name in BLOCK LETTERS and the signature of a Doctor, Bank Officer, Established Civil Servant, School Teacher or
someone of similar standing. They should also write on the back of the photograph “I certify that this is a true likeness
of Mr/Mrs/Miss/Ms/Dr etc……..” and add their signature. They must also provide their details at Section 7. A member
of your family is NOT allowed to counter sign your photograph. The back of the other photograph must include your
name in BLOCK LETTERS and your date of birth.

14. APPLICATION TRACKING

If you have provided an email address you will receive confirmation of receipt. We will then email you if we require any
further evidence. Once we have processed and approved your application we will dispatch your documents by
Recorded Delivery.

NOW RETURN YOUR COMPLETED APPLICATION TO YOUR LOCAL MCA MARINE OFFICE

Please address any queries about your application to your local MCA Marine Office. Contact details are available
from www.gov.uk .Search for “Marine Office”.

YOU SHOULD ALLOW AT LEAST 28 DAYS FOR US TO PROCESS YOUR APPLICATION, PLUS POSTAGE

AN INCOMPLETE APPLICATION WILL DELAY THE ISSUE OF YOUR LICENCE

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 BOATMASTER LICENCE TESTIMONIAL (Template)

To be submitted on the headed paper of the organisation represented.

This is to certify that:

Full Name

Date of Birth Place of Birth

has been known to me, or my organisation, as a commercial operator of inland waterway vessels,
as specified below between _ _ / _ _ / _ _ and _ _ /_ _ /_ _.

During this period of service, Mr/Ms ……………… has served in the following capacity(s):

Master for months/years;

Mate with duties as helmsman for months/years;

Other relevant duties (please specify)

for months/years;

for months/years.

Vessel Name

Registered (or Identification Number)

Overall Length (in m)

Breadth (in m)

Tonnage (dwt)

Type of Operation

Area(s) of Operation

Signed Name (Print)

Master or Position in Company

Name of Company

Company Stamp Date

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18. PAYMENT - All Applicants

Please enclose the appropriate fee (as laid down in the current Merchant Shipping Fees Regulations)
Payment should be made in pounds sterling (£) by cheque, postal order or banker's draft, BACS, credit or debit card.

Cheques, postal orders and banker’s drafts should be made payable to the "Maritime and Coastguard Agency" and crossed
"account payee" and "not negotiable". Cheques and banker’s drafts should be drawn at a UK bank. CASH WILL NOT BE
ACCEPTED.

Information regarding the fees can be found in section 12 of the guidance notes.

Please tick (✓) the appropriate box below to indicate your chosen method of payment.

Maestro Visa MasterCard Delta Cheque/banker’s draft Postal Orders BACS

Please charge £ to my Maestro / Visa / MasterCard / Delta Card

Name of Card Holder

Card Number
Start Date
Expiry Date
Maestro Issue Number (Maestro Cards Only

Security Code:

The Security Code is the last three digits of the numbers on the reverse of the card the card, near the signature strip.

Signature………………………………………………………………………… Date……………………………………………….

Receipts: If you would like confirmation your application has been received by the Marine
Office and a receipt for your fee payment please tick (✓ ) the box below and confirm the
email address these should be sent to:

Please confirm receipt of my application

Please issue me with a receipt

Email address:

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