CPC-2-3-07 - Maritime Mobile Service Identities (MMSIs)

Annex A - MMSI Application Form - Ship Station with VHF/DSC Only, Unlicensed Radio

IMPORTANT:  Be sure to fill out the correct ship station MMSI form (Annex A or B). Use this application form if the vessel does not require a radio licence and if the radio equipment on board consists of a VHF/DSC radio(s) with or without GPS or LORAN. In such case, a type 0 MMSI should be issued. If the vessel requires a radio licence or if additional radio equipment is installed, use the application form in Annex B.

Part B - Information ( denotes mandatory fields and x denotes mandatory fields if issued or installed):

	Applicant Name: Last, First
	Applicant Telephone Number: (include country code and area code)
	Applicant Mailing/Postal Address: (include postal code)
	Applicant Fax Number: (include country code and area code)
	Applicant Electronic Mail Address:
x	MMSI: Nine digit Maritime Mobile Service Identity beginning with 316 (mandatory only if previously issued or installed)
	Vessel Name:
	Ex Vessel Name: (in case of a modification to the vessel name)
	Vessel Owner Information: (if different from Applicant fields) Last, First or Company name:  Full mailing address including postal code:  Telephone (include country code and area code):  Fax:  Email:
	General Classification: Make a selection from Annex E
	Individual Classification(s): Make the appropriate selection(s) from Annex E
x	Ship Station Group MMSI: (if the vessel belongs to a group) (mandatory only if previously issued or installed)
	Gross Tonnage: Vessel's internal capacity in tons, 1 ton=2000 lbs. (for pleasure craft of 12 metres or less, see Annex E) _______ Tons
	Emergency Contact Person Ashore Name and Address:
	Emergency Contact Person Ashore Telephone Number: (include country code and area code)
	Emergency Contact Person Ashore Fax Number: (include country code and area code)
	Alternate 24-hour Emergency Telephone Number: An individual who is accessible at any time (include country code and 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 Vessel Length:  ____________ Metres
	Additional Information and/or Instructions: