Spectrum Management and Telecommunications

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

Annex B - MMSI Application Form - Ship Station with Radio Licence

IMPORTANT:  Be sure to fill out the correct ship station MMSI form (Annex A or B). Use this application form when a vessel requires a radio licence or if additional equipment is installed on board. 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, use the application form in Annex A.

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


Part B - INMARSAT mobile terminal(s) on board (select only one):

(Type 0 MMSI)

The vessel is NOT equipped with an INMARSAT mobile terminal standard B, C or M.

(Type 1 MMSI)

The vessel is, or soon will be, fitted with an INMARSAT mobile terminal standard C.

(Type 3 MMSI)

The vessel is, or soon will be, fitted with an INMARSAT mobile terminal standard B or M.


Part C - 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
mandatory
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
Radio Installation Information: Radio equipment on board (i.e. MF/HF MF/HF/DSC VHF VHF/DSC CB CELL PCS MSAT NBDP RTTY DF FAX NAVTEX LORAN INMARSAT-A-B-C-M-Mini-M-M4 EGC GPS SART)

Vessel Length:  ____________ Metres

x
Radio Call Sign: Radio call sign of the vessel as issued by Industry Canada (mandatory only if licensed)
 
Ex Radio Call Sign: (in case of a modification to the radio call sign)
x
Selective Call Number(s): Five digit selective call number(s) as issued by Industry Canada between 03200-03299 prefixed with the letter S if used for Sequential Single Frequency Code (SSFC) only or letter T if used also for Narrow-Band Direct Printing (NBDP) or NBDP only (mandatory only if previously issued or installed)
x
Number of Life Boats: Number of life boats fitted with or without radio apparatus (mandatory if installed)
x
Frequency(ies) for EPIRB: Operating frequency(ies) of the EPIRB equipment on board (mandatory if installed)
x

EPIRB Hex Identification Code(s): The fifteen hexadecimal character string, referred to as the beacon 15 Hex ID beginning with A78 (mandatory if installed, must be 15 characters)

Important Note: Register all Emergency Position Indicating Radio Beacon(s) (EPIRB) with the National Search and Rescue Secretariat, online at http://canadianbeaconregistry.forces.gc.ca or by phone 1-877-406-7671.

 

x
EPIRB MMSI: 9 digit MMSI number or 316 + call sign assigned to EPIRB
 
Nature(s) of Service: Make the appropriate selection(s) from Annex E
 
Service(s) Available: Make the appropriate selection(s) from Annex E
 
Service Hours: Make the appropriate selection(s) from Annex E
 
Telegraphy Frequency Band(s): Make the appropriate selection(s) from Annex E
 
Telephony Frequency Band(s): Make the appropriate selection(s) from Annex E
 
Accounting Authority (AAIC): The Accounting Authority Identification Code of the entity charged with the accounting for the vessel in respect to the maritime mobile and maritime mobile-satellite services. Make a selection from Annex E
 
AAIC Used for INMARSAT: If a separate entity from the above, the Accounting Authority Identification Code of the entity charged with the accounting for the vessel in respect to the maritime mobile-satellite service only. Make a selection from Annex E
 
Vessel Identification Number: The registration number (maximum 15 characters) as issued by the Transport Canada Ship Registrar or Service Canada, or the seven digit International Maritime Organization (IMO) Number as issued by the IMO
x
INMARSAT Identity(ies): INMARSAT Mobile Number(s) (IMN) assigned to each INMARSAT mobile terminal on board (mandatory if installed)
 
Additional Information and/or Instructions: 


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