This form should be completed to provide the Australian Fisheries Management Authority (AFMA) with all the necessary Inmarsat contact details to forward to emergency agencies in the case an emergency arises.

There is no fee for this transaction.

What you need to do

Post or fax this completed form to:

Australian Fisheries Management Authority

Box 7051

Canberra Business Centre, ACT 2610

AUSTRALIA

Fax:	+61 2 6225 5440

Phone: +61 2 6225 5555

Email: portpermit@afma.gov.au

Who can sign this form?

Trading Name – All individual or corporate owners of a trading name must be specified as the applicants and all sign this form.

Companies – A company may sign in any manner (including under seal) authorised by s127 of the Corporations Act 2001.

Co-Holders – If the concession is in more than one name (partnership or otherwise), all holders must sign this form. If there are more than two holders please attach and date a separate sheet.

Powers of Attorney – If a party signs under a Power of Attorney the attorney must state ‘Signed for (name of principal) by his/her/their/its attorney (name of attorney) pursuant to Power of Attorney Register number (number or date if not required to be registered in that State) who states that he/she has no notice of the revocation of the power’. A copy of the registered power should accompany this form.

Trusts – The beneficial interests in any trust will not be recognised by AFMA (see s47 FM Act). A Trustee may only sign and date this form as the legal owner in their own right.

Privacy information

The Australian Fisheries Management Authority (AFMA) is authorised to collect the information provided on this form under the Fisheries Management Act 1991. Information is collected pursuant to our data collection functions under the Fisheries Administration Act 1991 (section 7).

Consistent with AFMA’s objectives and/or functions and/or powers, the information provided may be disclosed to:

Australian, State and Territory governments and agencies involved in the enforcement of law;

Australian and International fisheries research and management organisations;

foreign governments in support of domestic and international obligations in relation to fisheries management, research and compliance; and

Australian, State and Territory governments and agencies involved in emergency services.

For more information about privacy please contact AFMA on 1300 723 621.

PART A – Vessel details

Vessel Name

Click here to enter text.

International radio call sign

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Phone number	(Code.)Enter number.

Mobile phone/ Satphone	Click here to enter text.

HF radio (frequency	Click here to enter text.

Fax number	(Code.)Enter number.

PART B – Vessel owner’s details

Name

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Address

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Click here to enter text.
Click here to enter text.	Postcode	enter text

Phone number	(Code.)Enter number.

Mobile phone/ Satphone	Click here to enter text.

Fax number	(Code.) Enter number.

Email

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@Click here to enter text.

PART C – Master’s details

Name

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Address

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Click here to enter text.
Click here to enter text.	Postcode	enter text

Phone number	(Code.)Enter number.

Mobile phone/ Satphone	Click here to enter text.

Fax number	(Code.)Enter number.

I authorise the Australian Fisheries Management Authority (AFMA) to disclose Inmarsat contact details to emergency agencies in accordance with AFMA policy.

Signature and date

Full Name

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