Government of Western Australia

Department of Transport
Maritime
Marine Pilot Licence Application Form
Shipping and Pilotage (Ports and Harbours) Regulations 1966.
When blank, this form is classed as OFFICIAL, when filled out, this form is classed as OFFICIAL-SENSITIVE.

Guidelines
The following information is required in accordance with Part 5 of the Shipping and Pilotage (Ports and
Harbours) Regulations 1966.
Please email your application and scanned documents to Port.Ops@transport.wa.gov.au
Initial applications:
1. Completed Marine Pilot Licence Application Form overleaf
2. Two passport size photos. (A good quality digital photograph).
• The photographs must be a full front view of your head and shoulders without any head covering or
tinted glasses.
• The background of the photograph must be plain and light coloured.
• The photographs must be less than one year old.
• Poor quality photographs will not be accepted.
3. A copy of your CV including any relevant training
4. A copy of your Certificate of Competency or valid Certificate of Recognition of the grade of
Master issued under Parts 70 & 71 of the Marine Orders made under the Navigation Act 2012
(Commonwealth).
5. Details of your trips/voyages as a pilot in the port or the pilotage area of which:
a. each trip is recorded in the Log Book Form (see overleaf) or provided in your own list of trips that
includes all details on the form.
b. your supervising pilot has provided a signed statement attesting to your skills and knowledge related
to your ability to act as a pilot in the port or pilotage area.
6. Evidence that an approved training course has been completed to a satisfactory standard.
7. A current copy of your Certificate of Medical Fitness that has been issued by a Medical Inspector who
has been appointed by the Australian Maritime Safety Authority (AMSA) or equivalent authority. You can
find details at www.amsa.gov.au/qualifications-training/international-qualifications/medical-fitness-international-certificates
8. If you cannot meet requirements 3 -6 above, the Department of Transport may accept documented
skills and experience that prove your ability to act as a pilot in a port or pilotage area. You must provide
specific details of your maritime experiences. For example include locations, dates, times, personal
references, and copies of any qualifications to support your application.
9. Pay the appropriate fee - current fees as detailed on the application form.
10. Please allow for a minimum of ten working days for processing of this application.
11. Incomplete applications will not be processed.

Submissions
Please submit your application, with all required documentation to:
Port.Ops@transport.wa.gov.au
Transport recommends that you retain a copy of your application for your records.

09-10-01-01-PT-0824
 Marine Pilot Licence Application Form
This application form is in accordance with regulations 9B, 9C and 9F of the Shipping and Pilotage (Ports and
Harbours) Regulations 1966. Please read the Marine Pilot Licence Application Guidelines before completing this
form and use block letters to complete this form.

Personal details
Family name:____________________________________________ Given name/s:____________________________________
Address:______________________________________________________________________ Post code:________________
Postal address: (if different from address)__________________________________ Post code:________________________
Contact phone number: (including area code)_____________________ Mobile number:_____________________________
Email: ___________________________________________________________________________________________________
Port or Pilotage area to which this application relates:_________________________________________________________

Submission Check List

Please ensure a copy of all the following documentation is included with your application. The numbers in brackets
indicate the corresponding Marine Pilot Licence Application Guideline number.

Requirements for initial applications

This completed application form (1) Supervising pilot’s signed statement
A digital photograph (2) (5)
CV (3) Certificate of Medical Fitness (7)
Certificate of competency (4) Approved training course (6)
Details of trips/voyages in the port or other pilotage area (5) Fee paid (9)

Applicant’s declaration
I (name in block letters)___________________________________________________ hereby declare that the particulars
entered in this application are correct and true to the best of my knowledge and belief, and that the certificates and
testimonials submitted are true and genuine documents, freely given and signed by the person whose name appears
on them.

Applicant’s signature_____________________________________________________________ Date____________________

Please allow for a minimum of ten working days for processing of this application.

Consent to disclose personal information

The Department of Transport, from time to time, needs to disclose confidential personal information to other agencies including, but not limited
to, the Department of Fisheries, Port Authorities, the Western Australian Police Force, the Swan River Trust, the Department of Environment and
Conservation, Local Shires and Councils and the Rottnest Island Authority. In providing the information requested in this form, you consent to the
Department disclosing the information to such other agencies.

Payment details
Fees and Charges - 2024/25 - Marine Pilots Licences
• Pilot Appointments - Application for Licence___________________________________ $611.10

To make a Credit Card payment over the phone please provide your preferred phone number.

Preferred Phone No.________________________________________________________________________________________________

 Proforma Log Book for Marine Pilots
Under Regulation 9C (3)(a) of the Shipping and Pilotage (Ports and Harbours) Regulations 1966, this is the approved Log Book form
or
if you prefer, you can create your own form that includes all the details on this form.

Conditions
Date & Time Size of Vessel Name of Signature of
Pilotage Area Date & Time In Day/Night for example: Name of Vessel
Out (gross tonnage) Supervising Pilot Supervising Pilot
Tidal/Wind

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out

/ / Date / / Date
am/pm am/pm In Out