Application for Survey

Before completing this form, we would suggest you read the accompanying notes regarding this service.

I apply for Survey as described below in accordance with either The Fishing Vessels (Safety Provisions) Rules 1999, as amended, or The Merchant Shipping (Survey & Certification) Regulations 1995 as amended, and provided under SELEX Communications Limited - Marine Division's Conditions of Supply of Radio Installation Surveys.

TYPE OF SURVEY / INSPECTION REQUIRED	Select
Radio Survey for the issue of Cargo Ships Safety Radio Certificate and associated Record of Equipment form
Radio Survey required for the issue of a Passenger Ship Certificate
Radio Survey required for the issue of a Fishing Vessel Safety Certificate
Radio Inspection for the issue of a Report of Inspection
Part Survey required for continuance of present certification due to a change of equipment
Radio-Navigation Survey required for the issue of a Cargo Ship Safety Equipment Certificate or Passenger Ship Certificate
Radio Survey for a Safety Standby Vessel

AGREEMENT	Select
In making this application, I agree to pay SELEX Communications Ltd. - Marine Division such fees as may be raised in connection with the survey in accordance with the the Merchant Shipping (Fees) Regulations currently in force.	I agree I disagree

YOUR DETAILS
Name		Rank
Owners/Agents
Address
Address (cont'd)
Postcode		Date
Phone		Fax
E-Mail
VAT Exemption	Yes No	VAT No

VESSEL DETAILS
Vessel
Official or Fishing No.
Port of Registry
Place of Survey
Survey Date	Time	Contact Tel.