Merchant Shipping Act, 1951 (Act No. 57 of 1951)

Regulations

Purchase

ANNEX

PRESCRIBED FORMS

FORM 1 (Regulation 3)

REPUBLIC OF SOUTH AFRICA

SOUTH AFRICAN MARITIME SAFETY AUTHORITY

APPLICATION FOR LICENCE (Section 68)

1.	I hereby apply for a licence for the vessel the particulars of which are furnished in this form.

2.	I declare that the particulars as furnished hereunder are to the best of my knowledge and belief true and correct:

PARTICULARS

(a)	Official number of vessel ....................................................................................

(b)	Name of vessel ...................................................................................................

(c)	Home port ...........................................................................................................

(d)	Description of vessel ...........................................................................................

(e)	Intended operation of vessel ..............................................................................

(f)	Number of crew including master .......................................................................

(g)	Full name and address of owner

...........................................................................................................................

(h)	Full name and address of applicant (if he or she is not the owner)

...........................................................................................................................

Date .........................................

...............................................................

Signature of applicant