Reply To: OUPV 6 PACK

[ShooterMcGrabbin]

If its on your boat it’s self reported. You just need to provide proof of boat registration, title, or other ownership documents.

If it was on another boat, the captain will have to sign off on a CG-719S.

Are you gonna start chartering or just want to level up your license?

Heres a format you could use to submit your time on your own vessel:

U.S. Coast Guard Small Vessel Sea Service Form (Self-Reported)

Applicant Name: ___________________________________

Date of Birth: ____________________________________

Address: _________________________________________

Phone / Email: ____________________________________

—

Vessel Information

Field Details

Vessel Name __________________________________

Vessel Registration / Documentation # __________________________________

Vessel Type (e.g., Power, Sail) __________________________________

Hull Material __________________________________

Propulsion (e.g., Outboard, Diesel, Sail) __________________________________

Length Overall (LOA) ______ ft

Gross Tons (if known) ______ GT (if unknown, leave blank)

Owner’s Name __________________________________

Applicant’s Relationship to Owner □ Self □ Family □ Friend □ Other __________

—

Service Record

From (MM/YYYY) To (MM/YYYY) Total Days Operated Waters Operated (e.g., Inland, Near Coastal) Duties Performed (check all that apply)

□ Operated Vessel □ Maintenance □ Navigation □ Lookout □ Crew Duties □ Other __________

□ Operated Vessel □ Maintenance □ Navigation □ Lookout □ Crew Duties □ Other __________

(Attach additional sheets if needed.)

—

Total Time Summary

Type of Water Total Days of Service

Inland __________ days

Near Coastal __________ days

Great Lakes __________ days

Total Days __________ days

—

Certification

I certify that the information provided above is true and accurate to the best of my knowledge. I understand that false statements may result in the denial or revocation of my license.

Applicant Signature: ___________________________

Date: ______________________

—

Vessel Owner Verification (if not applicant)

I hereby verify that the applicant served aboard my vessel as described above.

Owner Name: ___________________________________

Signature: ___________________________

Date: ______________________

Phone / Email: ___________________________________

—

Notary (Recommended but Optional for Self-Owned Vessel)

State of ___________________

County of __________________

Subscribed and sworn before me this _____ day of ___________, 20.

Notary Public: ___________________________

My Commission Expires: ___________________