RA367 - Amendments/Additions to Current Ship Radio Licence Details

Amendments/Additions to Current Ship Radio Licence Details

Please note: This form should be printed out and sent via 'surface mail' to the address given below. Please do not attempt to re-send this form via E-mail as we cannot at present handle electronic submissions.

Please print entire document.

RA 367 is also available in (44KB)

All three boxes below must be completed.

MMSI number
(If applicable)

Callsign

Licensee reference
(on your licence)

Tel: 0870 243 4433
Fax: 0117 921 8444

For a newly acquired vessel, use form RA 145.

SECTION 1 CHANGES TO RADIO EQUIPMENT

(Please sign and date at the bottom of the page on completion of this section)

Please indicate any changes since the licence was last issued:

	Quantity
	Added	Removed
VHF Fixed
Fixed VHF/DSC
VHF Portable
Portable VHF/DSC
MF/FT
HF/WT
MF/RT
HF/RT
VHF/DSC
MF/HF DSC
EPIRB 121.5/243 MHz
EPIRB 406 MHz
EPIRB 1.6 GHz
Aeronautical SAR 121.5/123.1 MHz
UHF Portable
Satellite Standard A
Satellite Standard B
Satellite Standard C
Satellite Standard M
SART
Radar

SECTION 2 CHANGE OF VESSEL'S NAME

(Please sign and date at the bottom of the page on completion of this section)

This section is ONLY to be used if changing the name of an existing licensed vessel. It cannot be used to transfer the licence between vessels. A new vessel requires a new application form RA 145 to be completed.

Old vessel name

New cessel name

SECTION 3 406 MHz/1.6 GHz EPIRB DETAILS

(Please sign and date at the bottom of the page on completion of this section)

Beacon Frequency

Beacon Manufacturer's name

Beacon Type (from the label on the beacon)

Beacon Serial Number (from the label on the beacon)

Hex Id (15 characters, if known)

SECTION 4 24 HOUR EMERGENCY CONTACT

This information must be supplied and will only be used by Search and Rescue Authorities in an emergency.

Name
Address

Postcode
Tel

Fax

SECTION 5 CHANGE IN CURRENT LICENSEE ADDRESS

(Please sign and date at the bottom of the page on completion of this section)

Licences are NOT transferable between persons – use form RA 145 to apply for a new licence for a newly acquired vessel

Registered address

Address

Town
County
Postcode
Tel

Fax

Mailing address

Address

Town
County
Postcode
Tel

Fax

SECTION 6 LICENCE NO LONGER REQUIRED

(Please sign and date at the bottom of the page on completion of this section)

	Tick below
Vessel sold
Vessel scrapped
Station decommissioned

Details of new owner

Name

Address

Town
Postcode

SECTION 7 DECLARATION

I declare that all of the details given above are correct to the best of my knowledge and that I will obide by the terms and conditions of the licence.

Signature of applicant/licensee

...............................................................

Full name (in block capitals)

Dated

If you are signing on behalf of a company or other organisation please state:

Name of organisation

Your position within the organisation

Please return this form to:
Radio Licensing Centre, P.O. Box 1495, Bristol BS99 3QS

RA 367 (Rev 2)
MAY 2003

Amendments/Additions to Current Ship Radio Licence Details

Please note: This form should be printed out and sent via 'surface mail' to the address given below. Please do not attempt to re-send this form via E-mail as we cannot at present handle electronic submissions.

SECTION 1

CHANGES TO RADIO EQUIPMENT

SECTION 2

CHANGE OF VESSEL'S NAME

SECTION 3

406 MHz/1.6 GHz EPIRB DETAILS

SECTION 4

24 HOUR EMERGENCY CONTACT

SECTION 5

CHANGE IN CURRENT LICENSEE ADDRESS

SECTION 6

LICENCE NO LONGER REQUIRED

SECTION 7

DECLARATION

Please return this form to: Radio Licensing Centre, P.O. Box 1495, Bristol BS99 3QS

Please return this form to:
Radio Licensing Centre, P.O. Box 1495, Bristol BS99 3QS