| Vessel Name |
|
| Radio Call Sign |
|
| MMSI |
9 Digit Code Required |
| IMO Number:
|
A-Z 0-9 Only
|
| Registration Number |
|
| Satellite Telephone No |
|
| Vessel Type |
|
| GRT |
|
| Length (metres) |
|
| Hull Colour |
|
| Deck Colour |
|
| Other Marks |
|
| Number of Survival liferafts |
|
| Number of Survival lifeboats |
|
| 1st Emergency Contact Name |
|
| Emergency Contact Telephone |
|
| Emergency Contact Alt Telephone |
|
| 2nd Emergency Contact Name |
|
| Emergency Contact Telephone |
|
| Emergency Contact Alt Telephone |
|
| Owners Name |
|
| Mailing Address |
|
| E-Mail Address |
*
|
RCC Bermuda will confirm your
submission.
To whom should this be sent? |
| Name |
|
| Facsimile Number |
|
| E-mail Address |
|
|
Please Give Details of your first EPIRB:
|
| COSPAS/SARSAT 15 Hex ID Code: |
15 Digit Hex Code Required
|
|
|
| Category |
|
| Beacon Manufacturer |
|
| Beacon Model Number |
|
| Serial Number |
|
| Address of Supplier |
|
| Supplier Telephone |
|
|
Please Give Details of your second EPIRB (If applicable):
|
| COSPAS/SARSAT 15 Hex ID Code: |
15 Digit Hex Code Required
|
|
|
| Category |
|
| Beacon Manufacturer |
|
| Beacon Model Number |
|
| Beacon Serial Number |
|
| Address of Supplier |
|
| Supplier Telephone |
|
|
Please Give Details of your third EPIRB (If applicable):
|
| COSPAS/SARSAT 15 Hex ID Code: |
15 Digit Hex Code Required
|
|
|
| Category |
|
| Beacon Manufacturer |
|
| Beacon Model Number |
|
| Beacon Serial Number |
|
| Address of Supplier |
|
| Supplier Telephone |
|
|
Please Give Details of your fourth EPIRB (If applicable):
|
| COSPAS/SARSAT 15 Hex ID Code: |
15 Digit Hex Code Required
|
|
|
| Category |
|
| Beacon Manufacturer |
|
| Beacon Model Number |
|
| Beacon Serial Number |
|
| Address of Supplier |
|
| Supplier Telephone |
|
| Reason for Submission |
|
|
Submit EPIRB Data
|
