Vessel Registration Form 3.

1
(Offl

Vessel Information

Vessel Name (Required)

IMO Number (Required)
Flag State (Required)
MMSI Number (Required)
Call Sign (Required)
Master Name (Required)
Vessel Type (Required)

Communication

Primary Email Address (Required)

Secondary Email Address
Ship Contact Number (Required)
Ship Contact Email (Required)
Owner Name (Required)
Operator Name (Required)
Operator Contact Number (Required)
Operator Email (Required)
Operator Address
Designated Person Ashore (DPA) Name (Required)
DPA Contact Number (Required)
DPA Email (Required)
Iridium number

Vessel Movement

Entry Point to MSCHOA Registration Area (Required)

ETA (UTC) (Required) (dd/mm/yyyy hh:mm)
Exit Point from MSCHOA Registration Area (Required)
ETD (UTC) (Required) (dd/mm/yyyy hh:mm)
Last port of call (Required)
Next port of call (Required)
Do you intend to transit the IRTC part of the MSTC? (Required)
(If YES) ETA at IRTC (UTC) (dd/mm/yyyy hh:mm)
(If YES) ETD at IRTC (UTC) (dd/mm/yyyy hh:mm)
 (If YES) select direction
Do you intend to join a group in transit? (Required)
(If YES) Group To Join
(If NO) Intend to join National Convoy?
Transit Speed (Required)
Max. Speed (Required)
Draft (Required)

Self Protection

AIS to be left on through GOA (Required)

AIS to be left on through HOA (Required)
Armed security on board? (Required)
(If YES) Embark Point
(If YES) Disembark Point
(If YES) Embark Date (dd/mm/yyyy)
(If YES) Disembark Date (dd/mm/yyyy)
(If YES) Company Home Base
(If YES) Name Of Company
(If YES) Number of armed personnel
Anti-Piracy Measure in place? (Required)
Crew Briefing
Fire hoses rigged
Fire Pump ready
Barbed/Razor Wire
External Communication Plan
Citadel
Dummies Posted
Manned Engine Room
CCTV
Crew Drills Completed
Extra Lookouts
Locked Doors
Night Vision Optics
Outboard Ladders Stowed
Unarmed Security
Weapons on board? (Required)
Doctor on Board? (Required)
Helicopter Winch? (Required)
Helicopter Landing Pad? (Required)
Freeboard or Lowest Point of Access (m) (Required)

Other information
Nationality & Number of Crew members (one per line - required)

Ship Cargo

Hazardous cargo details (If applicable)

Additional Information (If applicable)

Please send all completed forms to

m 3.1
(Offline form)

Vessel Information

Communication

Vessel Movement
 Self Protection

Other information
postmaster@mschoa.org