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

Annex C

MMSI Application Form - Coast Station

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 00316
	Licensee Name: Name of the radio licence holder
	Station Location: Name of the geographical location of the radio station
	Latitude: Latitude, in degrees, minutes and seconds, of the radio station
	Longitude: Longitude, in degrees, minutes and seconds, of the radio station
	Company Code: Nine digit company code as issued by Industry Canada
	Licence Number: Seven digit licence number as issued by Industry Canada
	Call Sign: Radio call sign as issued by Industry Canada
	Additional Information and/or Instructions: