|
|
MMSI: Nine digit Maritime Mobile Service Identity
beginning with 533 |
|
|
|
Vessel Name: |
|
|
|
Ex Vessel Name: (in case of a modification
to the vessel name) |
|
|
|
Radio Call Sign: Radio call sign of the vessel
as issued by Marine Dept/MCMC beginning with the prefix 9MA-9MZ and 9WA-9WZ |
|
|
|
Ex Radio Call Sign: (in case of a modification
to the radio call sign) |
|
|
|
Vessel Owner Name: Last, First or Company
name |
|
|
|
General Classification: Make a selection from
Annex F |
|
|
|
Individual Classification(s): Make the appropriate
selection(s) from Annex F |
|
|
|
Ship Station Group MMSI: (if the vessel belongs
to a group) |
|
|
|
Gross Tonnage: Vessel=s internal capacity
(for pleasure craft of 12 meters or less, see Annex F) |
|
|
|
Emergency Contact Person Ashore Name and Address:
Name and address of an individual ashore in case of emergency |
|
|
|
Emergency Contact Person Ashore Telephone
Number: Telephone number of an individual ashore in case of emergency (include area
code) |
|
|
|
Emergency Contact Person Ashore Fax Number:
Fax number of an individual ashore in case of emergency (include area code) |
|
|
|
Alternate 24-hour Emergency Telephone Number:
Other telephone number in case of emergency and accessible at any time (include area
code) |
|
|
|
Capacity for Persons on Board: Maximum number
of persons on board |
|
|
|
Radio Installation Information: Radio equipment
on board (VHF/DSC GPS LORAN) |
VHF/DSC |