EPIRB Registration Form


Vessel Name
Radio Call Sign
MMSI
IMO Number:
Registration Number
Satellite Telephone No
Vessel Type
GRT
Length (metres)
Hull Colour
Deck Colour
Other Marks
Number of Survival liferafts
Number of Survival lifeboats
1st Emergency Contact Name
Emergency Contact Telephone
Emergency Contact Alt Telephone
2nd Emergency Contact Name
Emergency Contact Telephone
Emergency Contact Alt Telephone
Owners Name
Mailing Address
E-Mail Address
RCC Bermuda will confirm your submission.
To whom should this be sent?
Name
Facsimile Number
E-mail Address
Please Give Details of your first EPIRB:
COSPAS/SARSAT 15 Hex ID Code:
Category
Beacon Manufacturer
Beacon Model Number
Serial Number
Address of Supplier
Supplier Telephone
Please Give Details of your second EPIRB (If applicable):
COSPAS/SARSAT 15 Hex ID Code:
Category
Beacon Manufacturer
Beacon Model Number
Beacon Serial Number
Address of Supplier
Supplier Telephone
Please Give Details of your third EPIRB (If applicable):
COSPAS/SARSAT 15 Hex ID Code:
Category
Beacon Manufacturer
Beacon Model Number
Beacon Serial Number
Address of Supplier
Supplier Telephone
Please Give Details of your fourth EPIRB (If applicable):
COSPAS/SARSAT 15 Hex ID Code:
Category
Beacon Manufacturer
Beacon Model Number
Beacon Serial Number
Address of Supplier
Supplier Telephone
Reason for Submission
Submit EPIRB Data