Belize

Application for Recognition as an Approved Seafarer Medical Practitioner

Complete all sections, attach the required supporting documents, and sign the declaration. After submitting, you will be redirected to complete the payment.

Application Type

Select the purpose of this submission.

Application Date: 2026-05-31

New Application Renewal Revalidation

Section 1: Personal Details

Surname (Last Name) Given Name(s) Date of Birth Gender Nationality Passport / ID Number Home Address Country Primary Telephone Email Address Account Email / Username

Section 2: Professional Practitioner Details

Medical Clinic / Hospital Name Physical Consultation Address City / State / Postcode Country National Medical License / Registration No. Date of First Registration Expiry Date Medical Specialties / Qualifications

Section 4: Required Supporting Documentation

Please attach certified English translations of the following files to this application.

Current Curriculum Vitae (CV)

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Medical Degree

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Copy of Valid National Medical License / Practicing Certificate

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Copies of Approval Certificates from Other Maritime Administration

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Proof of Identity (Passport or National Identity Card Page)

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Certificates or Qualification in Maritime Medical Training

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Evidence of Calibration Records for Diagnostic Audiometers and Vision Testing Tools

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Photos of Clinic Facilities

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Copy of Quality Standards System Covering Your Medical Assessment Procedures

Allowed: PDF, Word (.doc, .docx), PNG, JPG, or JPEG.

Section 5: Practitioner Declaration

I hereby declare that the information provided within this application form is true, accurate, and complete to the best of my knowledge. I understand that approval is subject to the terms of the Flag State Administration and compliance with STCW 1978 Regulation I/9 and the Maritime Labour Convention (MLC 2006). If approved, I agree to issue Seafarer Medical Certificates exclusively via the designated official format and guidelines.

I accept the practitioner declaration above.

Applicant Signature

Signature preview

This symbolic signature is generated from the given name(s) and surname entered above.

Date

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