Verification

SMART User Name:

Client Password:

Re-enter Client Password:

Name of Person Entering Change:

Your e-mail:

Callsign Details

Callsign to be edited:
ZME ZMF ZMG 2000-9999
Search Callsign Register

Radiotelephony Ship Details

Select installation type
VHF & MF/HF equipped
MF/HF (SSB) only

Vessel Name

INMARSAT Satellite Communications Equipment Fitted?
Radio Telex Number Required

Request to Release Callsign

Is this a request to release your Callsign?
No Yes

Details of Change Request

Please provide as many details as possible:

Emergency Contact

Emergency Contact Name


Emergency Contact Relationship


Emergency Contact Address


Emergency Contact Phone


Emergency Contact Mobile

Vessel Details

Type
Power Boat Launch Trailer Sailer Yacht RIB Dinghy Kayak PWC

Make	Model
Hull Construction Fibreglass Aluminium Steel Wood Glass/Ply Ferro Composite Rubber Plastic Other	Length (Metres)

Engine Type

Outboard

Inboard

Twin

Diesel

Petrol

Number of Engines	HP	Max Speed (Knots)
Auxiliary Engine No Yes	If Yes - HP:

Colour

Hull Colour


Deck/Cabin Colour


Trim Colour

Canopy Colour	Hard top? Yes No

Sail Colour

Rig Colour

Sail Number

Equipment Carried

VHF (Fixed) GPS (Fixed) Radar Lifejackets

VHF (Handheld) EPIRB Flares

SSB Fire Extinguisher Chart Plotter

Where and How Kept

Trailered at home Yes No

If No - Trailered at:

Trailer Registration Number

Marina

Mooring

Are there any other details that you wish to make available to the Rescue Coordination Centre of New Zealand, Maritime Operations Centre or other Search & Rescue Authorities?

Declaration

	In accordance with the Radiocommunications Regulations 2001, I hereby agree to observe all requirements and conditions, as determined by the Chief Executive for this type of certificate.  I certify that the information given herein is true and correct in every particular.
	Name of Applicant Date