Evidence of Identity – Alternate

Evidence of Identity for

(if you’re booking in multiple people, make sure you log out and log back in as each new user)

Click here to read the Evidence of Identity Requirements.

Evidence of Identity - Alternate

First Name *

Last name *

Mobile number *

Email *

Date of birth

(dd/mm/yyyy)

Current address (as it appears on your ID) *

Current address (as it appears on your ID)

Address line 1

Address line 2

City

State

Post code

Do you have a driver's licence? *

Yes

No

Evidence Of Identity Has Been Sighted By Mick

Yes

Driver's licence details

Photo Drivers Licence/Photo Learner Permit Number:

Other identity details

If you do not hold a drivers licence you will be required to provide two forms of ID from the list allowed by Maritime Safety Victoria. Click here to see the Evidence of Identity Requirements.

For you to be eligible for a certificate, Adam’s Boat Course staff must sight the original identification documents detailed on this form.
If you cannot demonstrate your residency through your identification you will need to complete a Referee Statement for Evidence of Address form.

Please contact us if you are unsure about the Evidence of Identity Requirements

Proof of identity primary ID type *

Proof of identity primary ID number *

Proof of identity secondary ID type *

Proof of identity secondary ID number *

Eligibility check *

I have been informed by Mick's Boat Course of the eligibility criteria to obtain a Marine Licence, as required by section 53 or 54 of the Marine Safety Act 2010 (Vic), and regulation 30 of the Marine Safety Regulations 2012 (Vic)

Student's Signature *

Clear

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Contact us

If you have any questions get in touch.

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0414 952 444