Merchant mariner medical certificate application third party authorization 2026

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field to authorize the U.S. Coast Guard National Maritime Center (NMC) to disclose information regarding your credential application.
Select the appropriate boxes that indicate what matters you are authorizing the third party to act on, such as professional qualifications or medical information.
Fill in the Third Party Information section with the organization name (if applicable), authorized person's mailing address, phone number, and email address.
Sign and date the form at the bottom, ensuring that you include your reference number or last four digits of your Social Security Number for identification.
Choose one of the four methods provided to send your completed authorization to the NMC.

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