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

Annex B

MMSI Application Form - Ship Station

IMPORTANT: Use this application form if the vessel requires a radio licence or if additional equipment is installed on board. 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, use the application form in Annex A instead.

Part A - Action:

Part B - INMARSAT mobile terminal(s) on board (select only one):

Part C - 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 (i.e. MF/HF MF/HF/DSC VHF VHF/DSC CB CELL PCS MSAT NBDP RTTY DF FAX NAVTEX LORAN INMARSAT-A-B-C-M-Mini-M-M4 EGC GPS SART)
x	Radio Call Sign: Radio call sign of the vessel as issued by Industry Canada
	Ex Radio Call Sign: (in case of a modification to the radio call sign)
x	Selective Call Number(s): Five digit selective call number(s) as issued by Industry Canada between 03200-03299 prefixed with the letter S if used for Sequential Single Frequency Code (SSFC) only or letter T if used also for Narrow-Band Direct Printing (NBDP) or NBDP only
x	Number of Life Boats: Number of life boats fitted with or without radio apparatus
x	Frequency(ies) for EPIRB: Operating frequency(ies) of the EPIRB equipment on board
	Nature(s) of Service: Make the appropriate selection(s) from Annex E
	Service(s) Available: Make the appropriate selection(s) from Annex E
	Service Hours: Make a selection from Annex E
	Telegraphy Frequency Band(s): Make the appropriate selection(s) from Annex E
	Telephony Frequency Band(s): Make the appropriate selection(s) from Annex E
	Accounting Authority (AAIC): The Accounting Authority Identification Code of the entity charged with the accounting for the vessel in respect to the maritime mobile and maritime mobile-satellite services. Make a selection from Annex E
	AAIC Used for INMARSAT: If a separate entity from the above, the Accounting Authority Identification Code of the entity charged with the accounting for the vessel in respect to the maritime mobile-satellite service only. Make a selection from Annex E
x	EPIRB Identification Code: The fifteen hexadecimal character string, referred to as the beacon 15 Hex ID beginning with A78
	Vessel Identification Number: The six digit Official Number (the national registration number as issued by Transport Canada Ship Registrar) or the seven digit International Maritime Organization (IMO) Number as issued by the IMO
x	INMARSAT Identity(ies): INMARSAT Mobile Number(s) (IMN) assigned to each INMARSAT mobile terminal on board
	Additional Information and/or Instructions: