Section A: Ship s Details

Transcription

1 MSD/MRCS/004/2012 Application Form for a Ship Station Licence (applicable only to SOLAS ships) With regard to radiocommunications equipment, in terms of the Electronic Communications (Regulation) Act (Cap.399), an individual licence is required for the installation or use of equipment, unless the equipment is licence exempt or is regulated by a general authorisation. Non-compliance with this requirement is a breach of the said Act. The licence fees chargeable for ship station licences are set out in the Fees (Radiocommunications) Regulations (S.L.35.01). 3. Maritime radiocommunications equipment, including that used for maritime radionavigation services shall comply with the Conformity Assessment of Marine Equipment Regulations (S.L ). 4. A ship station licence is an international document, which shall be kept current at all times and any discrepancies in the document will render the licence invalid. The original ship station licence should be kept on board the ship at all times and be available for production to appropriate authorities if required. 5. Duly completed applications must be submitted to Transport Malta (TM) at the address indicated in this form. 6. Certain data provided in this form will be made available to local & foreign entities, primarily for Search & Rescue (SAR) related purposes. Name of Ship Section A: Ship s Details Call sign MMSI No. AAIC PSA IMO No. Official No. Gross Tonnage Type of Ship Inmarsat Mobile Number/s Capacity for persons on board (crew & passengers) Sea Area of Operation (tick as appropriate) A1 A2 A3 A4 Name: Address: Section B: Registered Owners Details Telephone: Fax: Page 1 of 5

2 Section C: Radiocommunications Equipment Details C.1 VHF radio installation Transceiver DSC encoder C.2 MF radio installation Transceiver DSC encoder C.3 MF/HF radio installation Transceiver DSC encoder Direct-printing Radiotelegraphy C.4 INMARSAT ship earth station C.5 Facilities for reception of Maritime Safety Information (MSI) Navtex EGC HF Direct-printing Radiotelegraph C.6 Radar Transponders (SART / AIS-SART) Page 2 of 5

3 C.7 Two-way Hand Held VHF radiotelephones 3. C.8 Methods used to ensure availability of Radio facilities: Radiocommunications Equipment C.8.1 Duplication of equipment 3. C.8.2 Shore-based Maintenance Insert full Name & Address of company C.8.3 At-sea Maintenance Give details of personnel and qualifications C.8.4 Secondary means of alerting Insert Make, Type and Serial Number C.9 Other Equipment (applicable to all ships) Make Type Radar 1 X-Band S-Band Radar 2 X-band S-Band ARPA AIS GPS 1 GPS 2 SSAS LRIT OTHER Page 3 of 5

4 C.10 Other equipment (applicable only to Passenger ships) Passenger ships must comply with paragraphs 4, 5 and 6 of Regulation 6 Chapter IV of SOLAS 74 as amended. Does ship comply? Yes No If yes give details of equipment (make, type and serial number) and facilities to show compliance with the above paragraphs. Distress Alarm Panel VHF Two-Way on-scene transceiver for Search and Rescue on Frequency 125 and MHz. Any other radio equipment: (State make & type) Section D: EPIRB Registration Owners are required to attach a valid EPIRB Data Sheet Test / Programming Report with this form. The following information shall be completed by the EPIRB owner: Manufacturer s name Type Serial number Hex ID (15 characters) Device 1 Device 2 (if fitted) If the vessel carries more than two EPIRB stations, please provide details on a separate document. Page 4 of 5

5 Emergency Contact Person Ashore Section E: Search and Rescue (SAR) information Name... Address... Country... Tel:... Mobile:... Prefix of Telephone no. with country destination code. Fax: Alternative 24-hour emergency telephone number... Section F: Declaration I hereby declare that the information provided in this application is accurate and complete in all respects. Furthermore I also declare that I have due authority to make this declaration and to sign this application on behalf of the body I represent. Full name of applicant Designation ID / Passport Number Date Signature Page 5 of 5