CG-718A Certificate of Discharge to Merchant Mariner

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-718A (Rev. X/XX)

(Signature of Mariner)
Last Name (Print In Full)

First Name

C
r
R
e

Credential No.
or

Citizenship:

Date of Shipment:
Month/Day/Year (Example: 01/20/2012)

Reference No.

Foreign

Intercoastal

Coastwise

Other:

Month/Day/Year (Example: 01/20/2012)

Place of Discharge:

(Port or City, State or Country)

Name of Operating Company:

(Capacity in which employed)

Name of Ship:
Horsepower:

Official No.

I HEREBY CERTIFY that the above entries were made by me and are correct and that Class of Vessel:
the signatures hereto were witnessed by me.
Dated:
Month/Day/Year (Example: 01/20/2012)

Master's Reference No.

(Port or City, State or Country)

Middle Initial Date of Discharge:

Rating:

(Check only one box)

OMB-1625-0012
Expires X/XX/XXXX

Place of Shipment:

Name of Mariner:

Nature of Voyage

Print

Certificate of Discharge
to Merchant Mariner

Mode of Propulsion:

(Signature of Master)

Note - This form is required by law (46 USC 10311). Failure to submit can result in a civil penalty
of $5,000 as prescribed by 46 USC 10321.

Tonnage:

Tank

Freight

Other:
Motor

Gas Turbine

Steam

Other:
GRT
or

ITC

Instructions

G
R
I
T

The vessel master or individual in charge shall prepare the CG-718A.
A Certificate of Discharge and two copies should be printed out.
All three copies of the form must be signed in ink by the vessel master and the discharged mariner.
Distribute the Certificates of Discharge as follows:
1 - One copy shall be given to the discharged mariner.
2 - One copy shall be mailed in accordance with Title 46 Code of Federal Regulation Part 14, Subpart C, by the operating company to the following address:
Commanding Officer
United States Coast Guard
National Maritime Center (NMC-41)
100 Forbes Drive
Martinsburg, WV 25404
3 - One copy shall be maintained by the operating company for a period of three years from date of issuance.

Privacy Act Statement
In accordance with 5 U.S.C. § 552a(e)(3), THE FOLLOWING INFORMATION IS PROVIDED TO YOU WHEN SUPPLYING PERSONAL INFORMATION TO THE U.S. COAST GUARD.
1. AUTHORITY WHICH AUTHORIZED THE SOLICITATION OF INFORMATION:
A. 46 U.S.C. § 10311
B. SEE 46 CFR PART 14.
2. PRINCIPLE PURPOSES FOR WHICH INFORMATION IS INTENDED TO BE USED:
A. TO ESTABLISH ELIGIBILITY FOR A MERCHANT MARINER'S CREDENTIAL, DUPLICATE CREDENTIAL, OR ADDITIONAL ENDORSEMENTS ISSUED BY THE U.S. COAST GUARD.
B. TO ESTABLISH AND MAINTAIN A RECORD OF THE PERSONS SEA SERVICE.
C. PART OF THE INFORMATION IS TRANSFERRED TO A FILE MANAGEMENT COMPUTER SYSTEM FOR A PERMANENT RECORD.
3. THE ROUTINE USES WHICH MAY BE MADE OF THE INFORMATION:
A. TO MAINTAIN RECORDS REQUIRED BY 46 U.S.C. 7319 AND 7502.
B. TO ENABLE ELIGIBLE PARTIES (i.e. the mariner's heirs or properly designated representative) TO OBTAIN INFORMATION.
C. TO PROVIDE INFORMATION TO THE U.S. MARITIME ADMINISTRATION FOR USE IN DEVELOPING MANPOWER STUDIES AND TRAINING BUDGET NEEDS.
D. TO DEVELOP INFORMATION AT THE REQUEST OF COMMITTEES OF CONGRESS.
E. TO PROVIDE INFORMATION TO LAW ENFORCEMENT AGENCIES FOR CRIMINAL OR CIVIL LAW ENFORCEMENT PURPOSES.
F. TO ASSIST U.S. COAST GUARD INVESTIGATING OFFICERS AND ADMINISTRATIVE LAW JUDGES IN DETERMINING MISCONDUCT, CAUSES OF CASUALTIES, AND APPROPRIATE
SUSPENSION AND REVOCATION ACTIONS.
4. WHETHER OR NOT DISCLOSURE OF SUCH INFORMATION IS MANDATORY OR VOLUNTARY (REQUIRED BY LAW OR OPTIONAL) AND THE EFFECTS ON THE INDIVIDUAL, IF ANY, OF NOT
PROVIDING ALL OR PART OF THE REQUESTED INFORMATION: DISCLOSURE OF THIS INFORMATION IS VOLUNTARY, BUT SUBJECT MARINERS MAY NOT BE PERMITTED TO ENGAGE IN
EMPLOYMENT ABOARD THE VESSEL FOR WHICH CERTIFICATES OF DISCHARGE ARE REQUIRED.

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The United States Coast Guard estimates that the average burden for this report is 2 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions
for reducing the burden to the National Maritime Center, 100 Forbes Drive, Martinsburg, WV 25404, or Office of Management and Budget, Paperwork Reduction Project (1625-0012),
Washington, DC 20503.

U.S DEPT OF HOMELAND SECURITY, USCG, CG718A (Rev. X/XX)

PREVIOUS EDITION OBSOLETE