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We determine your authority to maintain your callsign with the SMART User Name and password of the holder of the callsign.

Verification

SMART User Name:

Client Password:

Re-enter Client Password:

Name of Person Entering Change:

Your e-mail:

Callsign Details

Callsign to be edited:
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?

Details of Change Request

Please provide as many details as possible:

Contact Details

Private Phone


Mobile Phone


Residential/Physical Address

Emergency Contact

Emergency Contact Name


Emergency Contact Relationship


Emergency Contact Address



Emergency Contact Phone


Emergency Contact Mobile

Vessel Details

Type

Make
Model
 
Hull Construction
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

 

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