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Form “C”

NATIONAL TELECOMMUNICATIONS COMMISSION


Radio Regulations and Licensing Department
RADIO OPERATOR AND TRAINING SCHOOL DIVISION
BIR Road, East Triangle, Diliman, Quezon City

Application for NEW/RENEWAL/REVALIDATION


Of STCW Certificates

  GOC – Certificate of Competency (COC)


  REC – Certificate of Endorsement (COE)

Date:

NAME:
Family Name Given Name Middle Name.
Mailing/Home
Address:
Telephone Nos.
Height: Date of Birth
Weight: Place of Birth:

Place and date of examination:

I HEREBY CERTIFY that I have read and understood the instruction and attached the requirements as
stated in this application form.

Signature over printed name

EVALUATOR CRS Verification CASHIER

REQUIREMENTS TO BE SUBMITTED:
** All applicants for the issuance of GMDSS Certificate must be medically fit and should be with good eyesight and hearing. The
latest medical Certificate using the DOH approved seafarers pre-employment medical form must be submitted together with the
application for issuance of GMDSS Certificate.

New (ROC/GOC) Renewal (ROC/GOC)


1. Original copy of the Result of Rating of Examination 1. Original copy of the Certificate to be renewed
2. Duly accomplished application form (form C) 2. Duly accomplished application form (form C)
3. Duly accomplished (notarized) information sheet
(form D) 3. Four (4) identical copies 1” X 1” ID picture
4. Four (4) identical copies 1” X 1” ID picture 4. Certificate of Sea Service (Employment or Copy of SIRB)
5. Documentary Stamp performing functions appropriate to the license held for a
period of at least one (1) year in total for the preceding five (5)
years.
5. Documentary stamp
New (REC) Renewal (REC)
1. Original copy of the Result of Rating of Examination. 1. Original copy of Certificate to be renewed.
2. Duly accomplished application form (form C). 2. Duly accomplished application form (form C).
3. Copy of valid Radio Operator’s Certificates (GOC/1RTG). 3. Copy of valid Radio Operator’s Certificates (GOC/1RTG).
4. Three (4) identical copies 1” X 1” ID picture. 4. Four (4) identical copies 1” X 1” ID picture.
5. Documentary stamp Documentary stamp
6. Certificate of Sea Service (Employment or Copy of SIRB)
performing functions appropriate to the license held for a
period of at least one (1) year in total for the preceding five (5)
years.

Revalidation
1. Original copy of STCW Certificate to be revalidated
2. Copy of Certificate of Completion of refresher course
3. Accomplished application form (form C)
4. Four (4) identical copies 1” X 1” ID picture
5. Copy of valid Radio Operator’s Certificates (GOC/1RTG) – for REC
6. Documentary stamp
FEES PER YEAR
GOC P180.00 ROC P180.00 REC P380.00

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