Application for Registration Forum Fisheries Agency Vessel Register

FFA 10-Oct-14 (Page 1 of 2)
Forum Fisheries Agency Vessel Register
VID number – FFA use only
Application for Registration
(use block letters)
1. Vessel
Name of Fishing vessel in English
Flag State
International call sign
MMSI (if issued)
Flag State Number
Port of registry
6. Vessel Charterer/Commercial Operator
Name
Mailing address
Date Entered onto Flag State Register
Fax number
Phone number
2. Vessel's previous details
E-mail address
Parallel Registry (if applicable)
Date Ship De-registered
(by the previous flag state, if applicable)
7. Vessel Fishing Master
Has a previous FFA Vessel Register application been made for
this vessel ?
if a vessel_id number was issued, provide
No
Yes
this number
Name
Mailing address
UVI/IMO Number if Issued
Vessel's previous name
Phone number
Last radio call sign
E-mail address
Last country of registration
Last flag state registration number
Year change occurred
Fax number
8. Vessel Type
Single Purse Seiner
3. Vessel contact details
Phone number
Fax number
E-mail address
No. FADs on board
No. Auxiliary boats
Helicopter model
Group Purse Seiner
Mothership
4. Vessel Registered Owner
Name
Net boat
Search boat
Longliner
Length specified as:
Max number hooks Mainline length
Mailing address
km
Phone number
nm
Mainline material
Fax number
Polyster (black tarred or vinyl red tarred) -includes
Kuralon, Dacron and Polytex
E-mail address
Nylon or Polyamide Nylon (monofilament or braided)
Other - specify
5. Vessel Master/Captain
Name
Pole and line
Mailing address
Bunker
Fish Carrier / Reefer
Troller
Other - specify
9. Vessel Specifications
Gross tonnage
Phone number
E-mail address
Fax number
Year built (year of initial launch)
Ship Builder
Country built
Hull material
Steel
Wood
Fibreglass
Other – specify
Aluminium
FFA 10-Oct-14 (Page 2 of 2)
Net Tonnage (if applicable)
Moulded Depth
Dead Weight (if applicable)
Beam
13. Applicant declaration
I hereby apply for 'Good Standing' of the (name of vessel)
Vessel length (complete all lengths)
on the FFA Vessel Register.
Registered length
Length overall
Lengths specified as:
metres
feet
Length between perpendiculars
Normal crew compliment
Rated speed (knots)
I declare that, to the best of my knowledge, there are no
outstanding matters pending in relation to this vessel or its use.
● I declare that the information provided in this application for
registration, signed by me is true, accurate and complete.
●
●
Amount specified as:
gallons
kilolitres
Total fuel carrying capacity
Total power of main Engine or Engines
Amount specified as:
●
HP
KW
PS
Engine model
Amount specified as:
Total storage capacity
cubic metres
metric tonnes
Major storage methods
I understand that I am required to report any changes to the
information provided within 60 days, and further understand
that failure to do so may adversely affect the good standing of
this vessel on the FFA Vessel Register.
As the owner/charterer/duly authorised agent of the
ALC/MTU identified above and installed on this vessel, I
hereby authorise Pacific Islands Forum Fisheries Agency to
electronically monitor the unit and disseminate data received
from it, in accordance with the FFA policy.
Signature
Date _____/____/____
Ice
Refrigerated sea water
( dd
Brine (NaCl)
Air (coils)
mm
yy )
14. Attachments
10. Vessel's Mobile Transceiver Unit (MTU) Details
Visit the FFA web site (www.ffa.int) or contact FFA for listing
of VMS Type-Approved MTUs and Installers.
Provide the MTU information details below.
●
●
●
●
Inmarsat Mobile Number (IMN)
●
Inmarsat Serial Number (ISN)
●
MTU Serial Number
Attach the following documentation to your application:
a copy of the vessel's flag state registration certificate;
a copy of valid flag state authorisation to fish outside of its
EEZ and within the WCPFC Convention Area;
company ownership details and proof of corporate registration;
a recent (12 months or less) date stamped, 15cm x 20cm
(6”x8”) color side-view & plan-view photos of the vessel;
copy of the vessel's schematic stowage plan; and
copy of the MTU inspection certificate.
15. Authorised MTU installer / Service agent details (15. &
16. required for new or replacement MTU installations)
MTU Manufacturer
MTU Model Identification
Name
MTU Software Version
Company Name
11. Applicant details
Company contact details
Name
Mailing address
16. MTU installer declaration
Fax number
Phone number
E-mail address
Tick the box that applies to you
Charterer
Owner
Authorised agent
I, ______________________________________________,
the installer of the Mobile Transceiver Unit identified above
declare that I have installed the specified unit in accordance
with the MTU/ALC vendor's installation guidelines and the
unit has been inspected in accordance with FFA's 'MTU/ALC
Inspections Guidelines' as published from time to time.
12. Application period
from
Year
Month
/
Month
to
Year
/
Privacy and your information
Information provided to the Pacific Islands Forum Fisheries Agency
(FFA) on this form is confidential unless the information is available
in the public domain. Further information about vessel registrations/
re-registrations guidelines, MTU inspections, including instructions
regarding remittance of vessel registration fees, will be provided in a
separate notice.
Signature _________________________ Date ____/____/____
( dd
mm yy )
(MTU installer / Service agent)
Send your completed form and documentation to:
Forum Fisheries Agency
1 FFA Road, Kola'a Ridge
PO Box 629
Honiara
Solomon Islands
Phone: (677) 21124
Fax:: (677) 23995
email: [email protected]