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Form

ML5 medical report form and certificate (MSF 4112)

A report for your medical history and current health; lets your doctor decide on your fitness to work safely at sea.

Updates to this page

From:
Maritime and Coastguard Agency
Published:
17 April 2014
Last updated:
9 January 2026
Show all updates

  1. Added text to landing page. Replaced PDF with the new version of ML5.

  2. Updated ML5 medical report and certificate 13th February 2023.

  3. Updated ML5 medical report form and certificate MSF 4112 February 2023.

  4. Updated with a revision of the seafarer medical report (ML5) and ML5 certificate (MSF 4112) November 2021.

  5. Most recent ML5 form added

  6. Latest ML5 medical form added

  7. September 2016 Revision Uploaded

  8. First published.

Documents

Seafarer medical report form ML5 and ML5 certificate (MSF 4112)

PDF, 512 KB, 14 pages

Details

Download and print these forms, and take them to your doctor to be filled in. It doesn’t have to be a Maritime and Coastguard Agency (MCA) approved doctor).

This form is for:

  • anyone applying for, revalidating, or changing their MCA Boatmaster’s Licence or certificate
  • anyone applying for a Royal Yacht Association (RYA) commercial endorsement for working on code vessels (see the form for more detail)
  • crew on a seagoing or domestic passenger vessel
  • working on a fishing vessel under 24m in length that is not subject to inspection in a foreign port, at sea for more than 72 hours or operating more than 200 miles from the coastline of the UK or beyond the continental shelf.

The previous revision (REV 02/23) of the ML5 Report Form and Certificate will continue to be accepted for new referrals up to and including 31st December 2026. After this date only examinations and new certificates conducted on the new form revision (01/26), will be accepted.

If your ML5 Certificate was issued on the old revision, on or before 31st December 2026, it will continue to be accepted for use on board until its expiry, or until there is a change in the holder’s medical history, whichever is the soonest.

If you have any questions regarding the new form, please do not hesitate to contact us at medical@mcga.gov.uk

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