n.b. i before any apparatus for wireless telegraphy may be
TRANSCRIPT
MALTA MARITIME AUTHORITY
Merchant Shipping Directorate
APPLICATION FOR A PERMANENT SHIP RADIO STATION LICENCE APPLICABLE ONLY TO SHIPS COMPLYING WITH GMDSS REQUIREMENTS
WARNING to all applicants - Any false statement, misrepresentation or concealment of material fact on this form or any document presented in support of this application may be grounds for criminal prosecution. INFORMATION PROTECTED - Personal information provided in your application form is protected and used in accordance with the provisions of the Data Protection Act.
I N.B. (i) Under the Radiocommunications Act (Chapter 49), an application for licence in writing is necessary before any apparatus for wireless telegraphy may be installed or worked.
i (ii) complete a s applicable
' m I I ................................................... I Name of Ship Call Sign
I MMSI No.
Selcall No.
AAIC
.................................................. Iamarsat "An Mobile No. ...............................
................................ .............................. .... ............ Inmarsat "Bn Mobile No.
.................................................. Inmarsat "Cn Mobile No. ............................. ~ ~
Gross Tonnage ................................................... Inmarsat "Mn Mobile No. ................................
Registration No. ................................................... Inmarsat "Mini-Mn Mobile No. ...........................
Date on which keel was laid .............................. Class of Ship ................................
Port of Registry ...................................................
Sea Area of Operation (tick as appropriate) +
.............................................................................................. Place where apparatus will be installed
Date when installation will be completed ..............................................................................................
Name and Address of Registered Owners
I I
1 Name of Applicant ......................................................... Identity Card No .................................... I
Whether Shipowner, Agent or otherwise ................................................................................................
Address ................................................................................................................................................................
.................................................................................. Telephone No .............................................
Date ......................................................... ........................................................ Signature..
Merchant Shipping Directorate. Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 2125 0360 Fax: +356 2124 1460 E-Mail: [email protected]
VHF radio installation
Insert Make, Type and Serial Numbers:
Make
DSC encoder
DSC watch receiver
Radiotelephone/
Transmitter
Receiver
lldF radio installation
DSC encoder
DSC watch receiver
Radiotelephone Transmitter/ Receiver
Serial Number
MF/HF radio installation
Make
DSC encoder
DSC watch receiver
Type
Radiotelephone Transmitter/ Receiver
Serial Number
Direct-printing Radiotelegraphy
Merchant Shipping Directorate, Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 2125 0360 Fax: +356 2124 1460 E-Mail: [email protected]
Make Type Serial Number
*
INMARSAT ship earth station
Facilities for reception of Maritime Safety Information ( MSI ) :
Make
1.
2.
Navtex receiver
EGC receiver
Type
HF Direct- printing Radiotelegraph receiver
Serial Number
Satellite EPIRB:
Make
COSPAS- SARSAT
Type
INMARSAT
Serial Number
Make
Expiry date of:
1 Battery I I Hydrostatic release I
Type
VHF EPIRB:
Serial Number
I Make I Type I Serial Number
Radar Transponders (SARTs)
Expiry date of battery
Make
1.
2.
Merchant Shipping Directorate, Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 2125 0360 Fax: +356 2124 1460 E-Mail: [email protected]
Type Serial Number
21 82 KHz Radiotelephone Watchkeeping Receiver
21 82 KHz Radiotelephone Alarm Signal Generating Device
Make
Two-way Hand Held VHF radiotelephone apparatus:
Type Serial Number
Serial Number Make
Battery (Expiry date and/or rechargeable)
'-bPe
Make
1.
2.
3.
Methods used to ensure availability of Radio facilities:
1. Duplication of equipment
m e Serial Number
2. Shore-based Maintenance Insert Name 86 Address of company (Furnish copy of Agreement)
1
2
3
3. At-sea Maintenance Give details of personnel and qualrjications
Secondaty means of alerting Insert Make, Type and Serial Number
Radiocommunication Equipment in use
Ship's main source of energy State voltage, phase, frequency
Ship's emergency source of energy State voltage and capacity
Make
Location
Merchant Shipping Directorate, Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 21 25 0360 Fax: +356 21 24 1460 E-Mail: [email protected]
?'ype Serial No.
Ship's reserve source of energy
If Battery state also:
Voltage AHC
Location of batteries
Automatic battery charger (state make and type)
Maximum charging current
Total Current Consumption
Insert make and type:
Direction Finder
Date of Calibration
Radars
OTHER EQUIPMENT
ARPA
Loran Decca Navigator Sat Nav
Last date Calibration check
Frequency
Other equipment (Passenger ships only)
Passenger ships must comply with paragraph 4, 5 and 6 Regulation 6 Chapter IV of SOLAS Consolidated Ed 1997.
Does ship comply? Yes P No p
If yes give details of equipment (make, type and serial number) and facilities to comply with these paras of Reg. 6 Chapter IV of SOLAS.
Merchant Shipping Directorate, Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 2125 0360 Fax: +356 2124 1460 E-Mail: [email protected]
VHF Two-Way on-scene transceiver for Search and Rescue on Frequency 121.5 and 123.1 MHz.
Make Type Serial Number
Any other radio equipment: (State make & type)
Radio Personnel 1. Name:
Class & Number of Certincate:
Date & Place of Issue:
2. Name:
Class & Number of Certificate:
Date & Place of Issue:
3. Name:
Class & Number of Certificate:
Date & Place of Issue:
Merchant Shipping Directorate, Malta Maritime Authority, Maritime Trade Centre, Marsa MRS 1912 Voice: +356 21 25 0360 Fax: +356 2124 1460 E-Mail: [email protected]