CG Form 719B – USCG Merchant Mariner Credential Application

Legal Name: Enter complete legal name. Include any aliases you have used and your maiden or prior name(s).

Social Security Number: If you are applying for an original credential, enter your SSN.

Reference Number: If you have been credentialed by the Coast Guard in the past, enter your reference number.

Alien Registration Number: If you are a legal alien, also enter your alien registration number (ARN).

Date of Birth: If the applicant is under 18 years of age, a notarized statement from legal guardian is required. Attach a notarized statement, signed by a parent or legal guardian, authorizing the Coast Guard to issue a credential.

Citizen: If not a U.S. citizen, please indicate country of nationality.

Place of Birth: City, State, Country. If born outside the United States, leave State blank.

Home Address: Principle place of residence. PO Box is NOT acceptable.

Delivery/Mailing Address: The address to which you want all correspondence and issued credentials sent. If blank, correspondence and credentials will be sent to the Home Address.

Primary Phone Number: Provide a primary phone number.

Alternate Phone Number: Provide an alternate phone number if available.

E-mail Address: The NMC may attempt to contact you via e-mail. If an e-mail address is provided, you will receive automated e-mail updates regarding the status of your application.

Next of Kin/Emergency Contact: Name & Mailing Address, City, State, Zip Code.

Relationship: Provide relationship status to next of kin listed on application (i.e. Mother, Father, Spouse).

Primary Phone Number: Phone number to contact the person listed in the event of an emergency.

Alternate Phone Number: Provide a cellular phone number, if available.

E-mail Address: Provide an e-mail address for Next of Kin listed.

An applicant must establish that he or she satisfies all the requirements for the MMC and endorsement(s) sought before the MMC is issued. The Coast Guard may refuse to process an incomplete MMC application.

All Mariners will receive a single Merchant Mariner Credential. Describe all desired capacities and limitations both national and STCW including tonnage, waters, propulsion mode, horsepower, ratings (Ordinary Seaman, Able Seaman, QMED-Oiler, etc.), purser, doctor, radio operator, continuity, etc.

Original MMC: An applicant must apply for an original MMC if they have never held any Coast Guard issued credential or if the first credential issued to applicant after their previous credential was revoked pursuant to 46 CFR Part 10. Complete the application and ensure all mandatory documents are contained with application.

Entry Level Ratings: There are no professional requirements needed when applying for entry level credential. Ratings may include Ordinary Seaman, Wiper, and/or Stewards Department / Stewards Department (Food Handler - F.H.).

Renewal MMC: A credential may be renewed at any time during its validity and for one year after expiration; you must be qualified to renew all Domestic/ STCW Officer and Rating endorsements to receive an MMC with a new five year expiration date. An MMC renewal-only transaction will automatically be issued with a date that coincides with the expiration date of your previous credential or a date that is 8-months from the time the Coast Guard accepted your application, whichever is sooner. Page 3, Section II of this form provides you the opportunity to decline this post-dating feature and your MMC will be valid immediately.

FOR RENEWAL TRANSACTIONS ONLY: I request to waive the post-dating feature and to have my merchant mariner credential (MMC) issued immediately. I decline having its issuance coincide with the expiration date of my current credential.

Unless specifically exempted, the Coast Guard must have evidence that you hold a valid TWIC or, for original applicants, that you have applied for a TWIC and are awaiting the results.

Criminal Record (Convictions and Drug Use): If you answer Yes to ANY of the questions in Section III you must disclose the information regarding the conviction. You may complete the optional form CG-719C for each question marked “Yes”.

National Driver Registry (NDR) Consent (Mandatory for Original, Renewal, or new Officer Endorsement): I authorize the National Driver Registry to furnish the U.S. Coast Guard (USCG) information pertaining to my driving record. This consent constitutes authorization for a single access to the information contained in the NDR to verify information provided in this application.

NOTE: Not required for Document of Continuity applicants.

CONSENT: I am under 18 years of age and a notarized statement of parental/guardian consent is attached.

Mariner Outreach System (Optional): I consent to voluntary participation in the Mariner Outreach System to be used by the Maritime Administration (MARAD) in the event of a national emergency or sealift crisis.

Per 46 CFR 10.225(c), an oath may by administered by any Coast Guard designated individual or any person legally permitted to administer oaths in the jurisdiction where the person taking the oath resides.

Failure to sign and date the application will result in the application being returned.

Certification: My signature attests that all information on this application is true and correct to the best of my knowledge.

I understand an application determined to be fraudulent may result in the denial of my application for one year from the date of submission, even if the fraudulent information was not by itself cause for denial or prosecution.

Third Party Authorization (optional): If you want the NMC to be able to discuss, release, or receive information/documents regarding your credential application with a third party (spouse, employer, school, union, etc.) you must provide specific guidance to the NMC regarding what issues the NMC may discuss and with whom.

You may allow release of all information to certain individuals or entities. If you limit the release of certain information you must be specific by making a selection on the application or by attaching additional documentation.

Duplicate MMC: In the event of a lost credential, a statement describing the circumstances of the loss must be submitted with the application.

If a person loses a credential by shipwreck or other casualty that causes damage to a ship, a duplicate will be issued free of charge as per 46 CFR 10.229.

If a person loses a credential by other means and applies for a duplicate, the appropriate fee set out in 46 CFR 10.219 must be paid.

Document of Continuity: This is a record of qualifications previously held and does not authorize the holder to sail in any capacity listed thereon. Documents of continuity do not expire, do not require medical or security evaluations, and do not require fees.