Spectrum Management and Telecommunications

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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 A - Action: 
Assign a new MMSI Modify an existing MMSI Cancel an existing MMSI

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

mandatory
Applicant Name: Last, First
mandatory
Applicant Telephone Number: (include country code and area code)
mandatory
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)
mandatory
Vessel Name: 
 
Ex Vessel Name: (in case of a modification to the vessel name)
mandatory

mandatory

mandatory

mandatory
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: 
mandatory
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)
mandatory
Gross Tonnage: Vessel's internal capacity in tons, 1 ton=2000 lbs. (for pleasure craft of 12 metres or less, see Annex E)

_______ Tons

mandatory
Emergency Contact Person Ashore Name and Address: 
mandatory
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)
mandatory
Capacity for Persons On Board: Maximum number of persons on board
mandatory




mandatory
Radio Installation Information: Radio equipment on board (VHF/DSC GPS LORAN)

VHF/DSC

Vessel Length:  ____________ Metres
 
Additional Information and/or Instructions: 


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