STATEMENT OF QUALIFICATION FOR VESSEL REGISTRATION

PROTECTED A (WHEN COMPLETED)
FORM 18
APPLICATION FOR BARE-BOAT CHARTER REGISTRY
FOR DEPARTMENT USE ONLY
Fee Paid
The proposed name is hereby approved
Reference number
Identification number
Date (dd-mm-yyyy)
For the Chief Registrar (CSA, 2001 S.44)
IMPORTANT INFORMATION
• This application must be completed and signed by the Bare-Boat Charterer who is also known as the Authorized Representative and must be qualified to
bare-boat charter a vessel registered in Canada.
• Qualifications to own a vessel registered in Canada are set out in Section 2 of the Canada Shipping Act, 2001 under "Qualified person".
• The process for bare-boat charter registration must be similar in both countries – conditional/provisional registration is not permitted.
VESSEL NAME AND PORT OF REGISTRY
I/We wish to apply for the name:
1st choice
2nd choice
Name of vessel requested
Name of vessel requested
Name of vessel requested
Intended port of registry
3rd choice
PARTICULARS OF VESSEL
Type of propulsion (select one)
Self-propelled
Method of propulsion (select one)
Auxiliary
None
Single screw
Twin screw
Particulars of propelling engines
Number of engines Engine description (select one)
Gas
Length (m.cm)
Diesel
triple screw
Jet
Other
Propulsion power (select one)
Other
BHP
Breadth (m.cm)
kW
Depth (m.cm)
Type of construction (select one)
Speed knot
Engine power
Gross tonnage
Net tonnage
Hull construction materials (select one)
Name of builder
Hull serial number
Place (City) and year of build
Province/State
Descriptor of vessel (select one)
Fishing (excludes sport fishing)
Passenger
Tug
If your vehicle is an air cushion vehicle (ACV), give details
Cargo
Other (specify)
All up weight
Model designation
KG
The vessel has previously been listed in Canada (select one) (if available, give details below)
Official number
Registered name
No
Yes
Port of registry
DETAILS OF UNDERLYING FOREIGN REGISTRATION
Official number
IMO number
Name of vessel
Port of registry
DETAILS OF EACH OWNER
Name(s) and address(es)
84-0170E (1509-09)
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Duration of Canadian bare-boat registry
Country
Country
PROTECTED A (WHEN COMPLETED)
FORM 18
DETAILS OF BARE-BOAT CHARTERER (Canadian address)
Name and address
Telephone number
Cell number
Fax number
Certificate in (select one)
E-mail address
English
French
STATE AS FOLLOWS (select one)
INDIVIDUAL
I am a Canadian citizen or a permanent resident within the meaning of Subsection 2(1) of the Immigration and Refugee Protection Act.
CORPORATION
A corporation incorporated under the laws of Canada and existing as per those laws at the time of this application.
A corporation incorporated under the laws of a Province and existing as per those laws at the time of this application.
NOTE: Partnerships are not accepted.
INDIVIDUAL
Signed at
Place
Signature of Bare-boat Charterer (Authorized Representative)
Date Application signed (dd-mm-yyyy)
CORPORATION
I
state that I have authority to bind
Name and title (Print)
I also state that
Name of corporation (Print)
as per the laws of Canada; OR
as per the laws of
Name of corporation (Print)
.
is the name of a corporation which legally exists at the date of this Application:
.
Name of province (Print)
This Application must be signed by the Bare-boat Charterer (Authorized Representative) who is an Officer or Director of the corporation who has the authority to
bind the corporation. Pursuant to Sections 51(2) and 75.01(2) of the Canada Shipping Act, 2001 applicants may be required to provide additional information
as requested by the Chief Registrar.
I understand that it is an offence for a person to knowingly make a false or misleading statement in writing and that the penalty can be a fine or imprisonment or
both if found guilty in a court of law (Section 37 of the Canada Shipping Act, 2001).
Signature of Bare-boat Charterer (Authorized Representative)
Date Application signed (dd-mm-yyyy)
The completed original application, required documents and payment of the fee must be mailed to:
Transport Canada
Vessel Registration, Marine Safety and Security
330 Sparks Street
Ottawa Ontario K1A 0N8
1-877-242-8770
Original or certified true copy of the Bare-boat Charter Party Agreement (English or French language)
Confirmation from the existing flag that bare-boat charter registration is permitted under the law of that flag
Certified abstract/transcript of registration of the vessel from the country of underlying registry showing all liens and mortgages
Written consent from the mortgagee(s) (if any)
Current International Tonnage Certificate (ITC)
Written consent from the owner(s)
Payment of appropriate fee $200.00 for each six(6) month period
The information you provide on this form is collected by Transport Canada for the purpose of registering your vessel. It is collected under the authority of Section 43 of the Canada
Shipping Act, 2001. The registration of your non-pleasure (commercial) craft is mandatory unless it is registered in a foreign state. The information will be held in the Department's
Personal Information Bank entitled Canadian Register of Vessels (bank number TC PPU 041). The information will be retained for 5 years after vessel is deregistered and then destroyed.
Your information will be handled in accordance with the provisions of the Privacy Act. Instructions for obtaining your personal information are provided in Info Source, a copy of which is
available in major public and academic libraries. Please note that under Section 76 of the Canada Shipping Act, 2001, a person may examine or obtain copies of any entries in the
Register with respect to a vessel.
84-0170E (1509-09)
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