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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.
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The use of all maritime radio transmission equipment on board a vessel must be covered either by a Wireless Telegraphy Act Ship Fixed or Portable Radio Licence.
Before completing this form, please read the accompanying guidance notes.
Please ensure that this application form is completed fully. Your application may be returned to you if it is not.
Important
2. The radio equipment covered by this licence must meet certain performance requirements as detailed in Section 3.0 of the guidance notes.
The Data Protection Act 1998
The information on this form is being collected on the authority of the Secretary of State for Trade and Industry and is to be processed for the purpose of issuing a Ship Portable Maritime Radio Licence. Authority for disclosure remains with the Radiocom-munications Agency and any request for information must be made in writing to:
The Data Protection Officer Radiocommunications Agency Wyndham House London E14 9SX
This information will be made available to the International Telecommunication Union and the Maritime and Coastguard Agency (in order to assist in search and rescue operations). It will also be released to the Police during the course of an official investigation, as well as to the Marine Administrations of the Isle of Man and Channel Islands.
1a Surname of licensee
Initials
Please indicate title (Mr, Mrs, Miss, Ms, Dr, other)
Or if vessel is company owned (see Section 7.5 of the guidance notes)
1b Company name
Name of company contact
2a Licensee address You must detail your permanent address or if this application is made on behalf of an organisation, the organisation's registered address Address
Postcode
Tel Fax
2b Mailing address (if different to to above) Only the validation document will be sent to this address.
3 Description of licensee You must tick one box only
Other organisation
(See Section 2.0 and 3.0 of the guidance notes)
4 Please indicate the type of equipment to be carried (please tick box)
Name
Address
Tel
Fax
IMPORTANT: The owner should contact the EPIRB REGISTRY if no acknowledgement is received within two weeks.
Contact:
The EPIRB Registry HM Coastguard Southern (Falmouth) Pendennis Point Castle Drive Falmouth Cornwall, TR11 4WZ.
Tel: 01326 211 569 Fax: 01326 319 264
(Please see Sections 2.3 and 6.0 of the guidance notes)
Ship Portable Radio Licence £15
Charity concessionary fee £8
Note:
The Radio Licensing Centre has been appointed as agent to distribute Ship Radio Licences on behalf of the Secretary of State for Trade and Industry.
In order to comply with the requirements of the Criminal Procedure and Investigations Act (CPI) 1996 all telephone calls to the Radio Licensing Centre are recorded.
Please print your name and customer reference number, if applicable, on the reverse of your cheque or postal order.
All payments must be in sterling and should be one of the following types:
i) a cheque drawn on a UK clearing bank; (must be in sterling with a UK sort code and account number) ii) a postal order; iii) an international bank draft drawn against a UK clearing bank, bearing the bankÕs sort code; iv) Mastercard, Visa, Switch or Visa Delta. BACS transfer credits are not accepted
If you wish to pay by credit or debit card please provide the following details:
Type of card
Card No.
Expiry
Card holder
If Switch please give Issue no. or valid from date
Please do not send your card
Future renewal payments
For future renewal payments you have the option of automatic payment made by Direct Debit instruction with your bank or building society. Paying by Direct Debit means you will not have to amend your instruction whenever there is a change in the licence fee. If you wish to pay by this method please tick the box below and the Radio Licensing Centre will forward a Direct Debit form to you
Please note you cannot pay for this year's licence by Direct Debit.
I declare that all of the details given above are correct to the best of my knowledge and that I will abide by the terms and conditions of the licence.
When you have completed the application form please send it, together with your cheque or postal orders for the current fee made payable to "Ship Radio Licensing" and crossed "A/C Payee" to:
Radio Licensing Centre P.O. Box 1495 Bristol BS99 3QS
Tel: 0870 243 4433 Fax: 0117 921 8444 Minicom: 0117 921 9550 (For hearing impaired customers ONLY, special equipment is required to use this service). Website: www.radiolicencecentre.co.uk E-mail: radio.licencing.centre@royalmail.com