Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

MD 698

Download as pdf or txt
Download as pdf or txt
You are on page 1of 4

香港特別行政區政府海事處

MARINE DEPARTMENT
THE GOVERNMENT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION

培訓合格證書申請表(遠洋)
Application for a Certificate of Proficiency (Seagoing)
註:填寫本表格前,請參閱第 3 至 4 頁的「填表須知」及「收集個人資料聲明」。
Note: Please read the ‘Guidance Notes’ & ‘Personal Data Collection Statement’ on page 3 to 4 before filling in this form.

1 Personal Details 個人資料


Surname 姓 Given Name(s) in full 名

Chinese Name 中文姓名(if applicable 如適用) Sex 性別 Date of Birth 出生日期 Nationality 國籍
(DD 日/MM 月/YYYY 年)

Telephone No. 電話號碼 Passport No. / H.K. Identity Card No. 護照或香港身分證號碼
(Home 住宅) (Mobile 手提)

Email 電郵 Seafarer’s Employment Registration Book No.海員僱用登記簿號碼

Full postal address (for acknowledgement and return of your documents) 回郵地址(通知及寄回文件之用)
(Home 住宅)

Applied Certificate of Proficiency and Details of Relevant Training Courses 申請簽發的培訓合格證書及相關訓練詳情


Issue Date of
Name of Training Institute Periods of Attendance
* Courses Attended 訓練學院名稱 訓練時間 Certificates
證書簽發日期
訓練課程
□ Personal survival techniques
個人求生技能
Basic Training
基本培訓

Fire prevention and fire fighting


基本消防訓練
Elementary first aid
基本急救
Personal safety and social responsibilities
人員安全和社會責任
□ Training in advanced fire fighting
高級消防培訓
□ Medical first aid
急救培訓
□ Medical care
醫護培訓
□ Proficiency in survival craft and rescue boats (other than
fast rescue boats)
救生艇筏及救助艇(快速救助艇除外)培訓
□ Proficiency as Ship Security Officer
船舶保安員培訓
□ Security training for seafarers with designated security
duties 指定保安職責培訓
□ Security awareness training
保安意識培訓
□ Basic training for oil and chemical tanker cargo operations
油船和化學品船貨物操作基本訓練
□ Advanced training for oil tanker cargo operations
油船貨物操作高級訓練
□ Advanced training for chemical tanker cargo operations
化學品船貨物操作高級訓練
□ Basic training for liquefied gas tanker cargo operations
液化氣體船貨物操作基本訓練
□ Advanced training for liquefied gas tanker cargo operations
液化氣體船貨物操作高級訓練
□ Proficiency in fast rescue boats
快速救助艇培訓

MD698 (Rev. 2022/03) Page 1 of 4


□ Basic training for service on ships using low-flashpoint fuels
使用低閃點燃料船舶船員基本訓練
□ Advanced training for service on ships using low-flashpoint fuels
使用低閃點燃料船舶船員高級訓練
□ Basic training for ships operating in polar waters
極地水域操作船舶船員基本訓練
□ Advanced training for ships operating in polar waters
極地水域操作船舶船員高級訓練
* please tick () which you are applying 請在申請的項目欄加上號

Certificates of Competency/Licences Held 現時持有之適任證書/執照


Class/Grade Certificate No. Issuing Authority Date of Issue Date of Expiry
級別 證書編號 發證機構 發證日期 有效日期
(DD 日/MM 月/YYYY 年) (DD 日/MM 月/YYYY 年)

Sea Service during the Preceding Three Years 最近三年海上服務資歷的記錄


Port of Registry & Date 日期
Ship’s Name Official Number Officer Rank
船名
船籍港及正式編號
職級 From 由 To 至

2 Company Name and Address for Correspondence 公司名稱及通訊地址

Email 電郵 : Fax 傳真 : Tel 電話 :

3 Declaration 聲明書
I declare that 本人謹此聲明:-
(i) I have read the‘Guidance Notes’ & ‘Personal Data Collection Statement’ appended to this application form carefully;
and
我已細閱此申請書附載的「填表須知」和「收集個人資料聲明」;以及
(ii) the information and documents submitted herein and with this application form are full, true and complete to the best of
my knowledge and belief.
就我所知所信,所有填報於此申請書的資料及一併提交的文檔均屬全面、真實及完整。
It is an offence under the Merchant Shipping (Seafarers) (Safety, Security and Designated Duties Training) Regulation, the
Merchant Shipping (Seafarers) (Tankers) Regulation, the Merchant Shipping (Seafarers) (Ships Operating in Polar Waters)
Regulation and the Merchant Shipping (Seafarers) (Ships Using Low-flashpoint Fuels) Regulation to give false information.
根據《商船(海員)(安全、保安及指定職責培訓)規例》、《商船(海員)(油船)規例》、《商船(海員)(極
地水域操作船舶)規例》和《商船(海員)(使用低閃點燃料船舶)規例》,提交不正確資料,實屬違法。

Signed by Applicant: Date:


申請人簽署: 日期:

For official use only 本處專用:


Result of application for issue of a CoP : Application Approved  Rejected 

Examiner: __________________________ Date: __________________________

MD698 (Rev. 2022/03) Page 2 of 4


GUIDANCE NOTES 填表須知
Please read the following Notes before completing an application 填寫培訓合格證書申請書時,請參閱以下的備註。
form for issue of a certificate of proficiency.

General 一般事項

1. The form should be completed in English (block letters) as far as 1. 請盡可能用英文正楷填寫此申請書。


practicable.
2. 申請人必須提供所需資料。請確保申請書各部
2. The supply of information is obligatory. Please ensure that all
parts in the form are completed and the information provided is 分均已填妥,且所填資料均正確無誤,以免申
accurate. Failure to do so may result in unsuccessful application. 請不獲處理。

3. Applications may be submitted in person or by post/email 3. 申 請 書 可 親 身 遞 交 或 郵 寄 / 電 郵


(ebs_crt@mardep.gov.hk) to the Seagoing Examination and (ebs_crt@mardep.gov.hk) 至海事處遠洋航行
Mercantile Marine Office, Marine Department, Room 302, 3rd 考試及商船海員管理處(地址:香港中環統
Floor, Harbour Building, 38 Pier Road, Hong Kong. Please 一碼頭道 38 號海港政府大樓 3 樓 302 室)。
contact this Seagoing Examination and Mercantile Marine
如欲查詢,請聯絡遠洋航行考試及商船海員
Office by (852) 2852 3148 for any enquiry.
管理處,電話: (852) 2852 3148。

Fee 收費
4. Certificate of Proficiency is issued free of charge. 4. 簽發培訓合格證書費用全免。

Approved training courses 認可訓練課程

5. Course completion certificates must be issued and signed by a 5. 修畢相關的認可訓練課程證書,必須由認可


responsible official of the approved training institution. 訓練機構的有關官員簽發。

Documents to be submitted 須提交文件

6. Applicant should submit the original of a completed application 6. 申請人須提交填妥的申請表正本及以下文件


form together with original and copy of the following 正本及影印副本(如適用)
documents, if applicable:
(a) 身份證明文件(香港身份證或護照)
(a) proof of identity (Hong Kong Identity Card or Passport)
(b) Discharge Book / Seafarer Employment Registration Book; (b) 海員辭職證書 / 海員僱用登記簿

(c) medical fitness certificate; (c) 體格檢驗證明書


(d) certificate of relevant training course approved by the (d) 海事處處長認可訓練課程證書;
Director of Marine;
(e) 訓練記錄簿;及
(e) Training Record Book; and
(f) 護照照片尺寸的近照兩張。
(f) two passport size photos.
(備註: (a)至(e) 項文件正本,可由影印副本
(Note: For items (a) to (e), a legible copy certified by a
替代。該等影印副本應清晰可閱並須由一位適
responsible public official, or the employer or public notary as
true copy can be accepted in lieu of the original.) 當的公職人員,或僱主或公證人核實。)

Recognition of Certificates Issued by Other Administrations 承認由其他主管機關發出的培訓合格證書


7. Seafarers holding Certificates of Proficiency issued pursuant to 7. 船員持有《STCW 公約》締約國根據《STCW
Chapter V and Chapter VI of the Annex to STCW Convention 公約》附則第 V 章和第 VI 章發出的,或是在
by, or under the authority of, the government of a state party to
其授權下發出的培訓合格證書,本處接受具
the STCW Convention. This Administration accepts those
certificates issued by STCW Convention parties to have the 同等效力,船員不需另行申請由本處簽發的
same effect as those issued by Hong Kong. These seafarers do 培訓合格證書。
not need to apply for a Certificate of Proficiency issued by this
Administration.

MD698 (Rev. 2022/03) Page 3 of 4


Personal Data Collection Statement 收集個人資料聲明

1. Purposes of Collection
1. 收集目的
The personal data provided by means of this form will be used
海事處會使用透過本申請表所獲得的個人資料
by Marine Department for the following purposes:
作下列用途:
(a) activities relating to the processing of your application in
(a) 辦理有關審批你在本申請表中所提出的申
this form;
請的事務;
(b) facilitating communication between Marine Department and
yourself; (b) 方便海事處與你聯絡;
(c) assisting in the enforcement of any other Ordinances and (c) 藉此協助其他政府決策局和部門執行其他
Regulations by other Government Bureaux and 法例和規例;
Departments; (d) 成功申請人的有限個人資料會用於海事處
(d) limited personal data of successful applicants may be used 的互聯網網頁以供第三者查證本處所發出
via the Marine Department’s Internet web site for 的證書;
verification of the issued certificate by any third party; (e) 供作統計及研究用途,但所得的統計數字或
(e) for statistics and research purposes on the condition that the 研究成果,不會以能辨識各有關的資料當事
resulting statistics or results will not be made available in a 人或其中任何人的身份的形式提供;以及
form which will identify the data subjects; and

2. Classes of Transferees 2. 獲轉交資料的部門╱人士


The personal data you provided by means of this form may be 你透過本申請表所提供的個人資料會向其他政
disclosed to other Government Bureaux and Departments for 府部門、決策局及有關機構,以作上述第 1 段
the purposes mentioned in paragraph 1 above. 所列的用途。

3. Access to Personal Data 3. 索閱個人資料


You have a right of access and correction with respect to 根據《個人資料 (私隱) 條例》第 18 及 22 條
personal data as provided for in Sections 18 and 22 and 及附表 1 第 6 條,你有權索閱及修正你的個人
Principle 6 of Schedule 1 of the Personal Data (Privacy) 資料。你的索閱權包括獲取本申請表所提供的
Ordinance. Your right of access includes the right to obtain a 個人資料副本一份。
copy of your personal data provided by this form.

4. Enquires 4. 查詢
Enquiries concerning the personal data collected by means of 有關透過本申請表收集的個人資料的查詢,包
this form, including the making of access and correction, 括索閱及修正資料,應寄往:
should be addressed to:
Officer-in-charge 香港
Seagoing Examination and Mercantile Marine Office 中環統一碼道 38 號
Marine Department 海港政府大樓 3 樓 302 室
Room 302, 3/F, Harbour Building 遠洋航行考試及商船海員管理處主管
38 Pier Road, Central 電郵: sssem@mardep.gov.hk
Hong Kong
Email: sssem@mardep.gov.hk

MD698 (Rev. 2022/03) Page 4 of 4

You might also like