8/12/2019 Form Met 160 51e

1/2

FORM MET-160-51E-00

To: NIPPON KAIJI KYOKAI Certification Serice !e"art#ent !ate:

APPLICATION FOR

CERTIFICATION OF MARITIME EDUCATION & TRAINING, etc.

I$ t%e &n'er(i)ne' a""*icant$ re+&e(t t%e NIPPON KAIJI KYOKAI$ to "roi'e t%e certification (erice( a(

'e(cri,e' ,e*o in accor'ance it% t%e .R&*e( for Certification of Mariti#e E'&cation / Trainin)

Na#e of trainin) co&r(e

A((e((#ent (tat&($ etc

Initia* A((e((#ent Renea* 2Certification No 3

Occa(iona* 2 3

Atten'ance to In(tr&ctor Trainin)

Na#e an' A''re((

Na#e of Or)ani4ation:A''re((:

Trainin) ocation 2A''re((3

T"e of Or)ani4ation:

Mariti#e Aca'e# Mariti#e Trainin) Centre

Mariti#e Si#&*ator Centre S%i" Mana)e#ent Co#"an 2in-%o&(e trainin) center3

S%i" oner 7 Mana)er Si#&*ator Man&fact&rer

Ot%er 2Ot%er S"ecif: 3

To" Mana)e#ent:Na#e: Po(ition:

Per(on in c%ar)e 2Contact "er(on3:Na#e: Po(ition:

Te*: Fa8:E-#ai*

2P*ea(e fi** in an a""ro"riate or)ani4ation or 'e"art#enta* e-#ai* a''re((3

Na#e of 9MS Man&a*2!ate of ate(t er(ion3

E8"ecte' 'ate foron-(ite a((e((#ent

A""*icant / i**in) A''re(( :a( (tate' ,e*o :a( (tate' a,oe

-Or)ani4ation

-Te* No

-Fa8 No

-Na#e / Po(ition

-Si)nat&re

2Attac%#ent 3

Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/)then fill out completel! and file with ClassNK.

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8/12/2019 Form Met 160 51e

2/2

FORM MET-160-51E-00 Attac%#ent

To: NIPPON KAIJI KYOKAI Certification Serice !e"art#ent !ate:

T%i( attac%#ent can ,e attac%e' for For# MET-160-51E-00 an' (&,#itte' to t%e NIPPON KAIJI KYOKAI

2C*a((NK3 to)et%er it% t%e (ai' for#

Enc*o(e' !ocentation for t%e A""roa* of a,oe Trainin) Co&r(e7Pro)ra##e:

Co&r(e fra#eor=

Co&r(e o&t*ine

Co&r(e (c%e'&*e

!etai*e' teac%in) (**a,&(

In(tr&ctor #an&a*

E8a#ination an' A((e((#ent

Co&r(e Criti+&e

Ot%er(

Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/)then fill out completel! and file with ClassNK.

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