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)01
Na#e of trainin) co&r(e
A((e((#ent (tat&($ etc1
Initia* A((e((#ent Rene-a* 2Certification No1 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) 5ocation 2A''re((3
T6"e of Or)ani4ation:
Mariti#e Aca'e#6 Mariti#e Trainin) Centre
Mariti#e Si#&*ator Centre S%i" Mana)e#ent Co#"an6 2in-
%o&(e trainin) center3
S%i" o-ner 7 Mana)er Si#&*ator Man&fact&rer
Ot%er 2Ot%er S"ecif6: 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 5ate(t er(ion3
E8"ecte' 'ate for
on-(ite a((e((#ent
A""*icant / :i**in) A''re(( :a( (tate' ,e*o- :a( (tate' a,oe
-Or)ani4ation
-Te*1 No1
-Fa8 No1
-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.
;01110<101
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#1
Enc*o(e' !oc&#entation for t%e A""roa* of a,oe Trainin) Co&r(e7Pro)ra##e:
Co&r(e fra#e-or=
Co&r(e o&t*ine
Co&r(e (c%e'&*e
!etai*e' teac%in) (6**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.
;01110<101