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.

Documents

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

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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
Published 17 April 2014
Last updated 15 August 2018 + show all updates
  1. Most recent ML5 form added
  2. Latest ML5 medical form added
  3. September 2016 Revision Uploaded
  4. First published.