RA 393 - Amendments/Additions to Current Ship Portable Radio Licence Details

Amendments/Additions to Current Ship Portable 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 393 is also available in (42KB)

Please ensure this form is signed and dated at the bottom and use capitals throughout.

All three boxes below must be completed.

Portable MMSI number
(if applicable)

T number

Licensee reference (on your licence)

Tel: 0870 243 4433
Fax: 0117 921 8444

SECTION 1 CHANGES TO RADIO EQUIPMENT

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

Please indicate changes since the licence was last issued:

	Added	Removed
VHF Portable
Portable VHF DSC
EPIRB 121.5/243MHz
EPIRB 406MHz
EPIRB 1.6GHz
Aeronautical SAR 121.5/123.1MHz

SECTION 2 406MHz/1.6GHz 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)

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

Relationship

SECTION 3 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 - ask for RA 385 to apply for a new licence.

Title

Forename(s)

Surname

Registered address

Address

Town

County

Postcode

Tel

Fax

Mailing address

Address

Town

County

Postcode

Tel

Fax

SECTION 4 LICENCE NO LONGER REQUIRED

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

	Tick below
Radio sold
Radio lost or destroyed

Details of new owner

Name

Address

Town

Postcode

SECTION 5 DECLARATION

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.

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

RA393
SEPTEMBER 2001