Get Merchant Mariner Medical Certificate Application Third Party Authorization

Filling out the Merchant Mariner Medical Certificate Application Third Party Authorization form online can streamline your credentials processing. This guide provides step-by-step instructions to help users navigate the form effectively and ensure all necessary information is included.

Follow the steps to complete the online form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the first section, print your full name clearly. This is necessary for identifying your application and authorizing the release of information.
3. Review the authorization box options. Select your preferred option by checking the corresponding boxes to specify which matters you authorize for third-party disclosure.
4. Fill out the Third Party Information section. Include the organization name (if applicable), authorized person’s mailing address, phone number, name, and optional email address.
5. Sign the authorization agreement, confirming your consent to disclose information. Include the date of your signature, following the format MM/DD/YYYY.
6. Provide your Mariner’s Reference Number or the last four digits of your social security number for identification purposes.
7. After completing the form, save your changes. You may choose to download a copy of the completed form, print it for records, or share it as needed.

Complete your Merchant Mariner Medical Certificate Application Third Party Authorization online today.