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.

From:
Maritime and Coastguard Agency
Published
17 April 2014
Last updated
25 November 2021 — See all updates

Documents

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

Ref: REV 11/21 PDF, 245 KB, 14 pages

This file may not be suitable for users of assistive technology.

Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email infoline@mcga.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

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 25 November 2021 + show all updates

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

  2. Most recent ML5 form added

  3. Latest ML5 medical form added

  4. September 2016 Revision Uploaded

  5. First published.

Related content

Brexit

Check what you need to do