CPC-2-3-07 - Maritime Mobile Service Identities (MMSIs)

Annex A

MMSI Application Form - Ship Station with VHF/DSC only

IMPORTANT: Use this application form if the vessel does not require a radio licence and if the radio equipment on board consists of a VHF/DSC radio(s) with or without GPS or LORAN. In such case, a type 0 MMSI should be issued. If the vessel requires a radio licence or if additional radio equipment is installed, use the application form in Annex B instead.

Part A - Action:

Part B - Information ( denotes mandatory fields and x denotes mandatory fields if issued or installed):

	Applicant Name : Last, First
	Applicant Telephone Number: (include country code and area code)
	Applicant Mailing/Postal Address: (include postal code)
	Applicant Facsimile Number: (include country code and area code)
	Applicant Electronic Mail Address:
x	MMSI: Nine digit Maritime Mobile Service Identity beginning with 316
	Vessel Name:
	Ex Vessel Name: (in case of a modification to the vessel name)
	Vessel Owner Name: Last, First or Company name
	General Classification: Make a selection from Annex E
	Individual Classification(s): Make the appropriate selection(s) from Annex E
x	Ship Station Group MMSI: (if the vessel belongs to a group)
	Gross Tonnage: Vessel’s internal capacity (for pleasure craft of 12 meters or less, see Annex E)
	Emergency Contact Person Ashore Name and Address: Name and address of an individual ashore in case of emergency
	Emergency Contact Person Ashore Telephone Number: Telephone number of an individual ashore in case of emergency (include country code and area code)
	Emergency Contact Person Ashore Fax Number: Fax number of an individual ashore in case of emergency (include country code and area code)
	Alternate 24-hour Emergency Telephone Number: Other telephone number in case of emergency and accessible at any time (include country code and area code)
	Capacity for Persons on Board: Maximum number of persons on board
	Radio Installation Information: Radio equipment on board (VHF/DSC GPS LORAN) VHF/DSC
	Additional Information and/or Instructions: