| (Regulation 19) |
| APPLICATION FORM FOR A LOCAL FISHING VESSEL LICENCE |
| (............................................................) |
| INSTRUCTIONS — Underline Surnames. |
| For “address” provide as much detail as possible. |
| If not applicable, write NA – leave no blanks. |
| Specify units of measurement if not metric. |
| ADDRESS TO — The Chief Fisheries Officer, (......................................) |
| I ............................................................ hereby apply for a local fishing vessel licence for the vessel described below: |
| 1. | Name of vessel ............................................................................ |
| 2. | Name and age of owner ................................/.............................. yrs. |
| and address ................................................................................ ............................................................................................. |
| 3. | Name and address of charterer ............................................................ ............................................................................................. |
| 4. | Name and address of any other person having an interest in the vessel ..................................................................................................... |
| 5. | Registration marks and number .......................................................... |
| 6. | International radio call sign (if any) ...................................................... |
| 7. | Name and age of master .............................................................. and address ................................................................................ ............................................................................................. |
| 8. | Nature of fishing operation to be undertaken (X as appropriate) |
| (a) | trolling |
| (b) | trapping |
| (c) | longlining |
| (d) | seining |
| (e) | gillnetting |
| (f) | trawling |
| (g) | handlining |
| (h) | any other |
| 9. | Navigational and safety equipment ....................................................... |
| 10. | Colour of vessel (inside/outside) .......................................................... |
| 11. | Fishing registration number of owner, charterer or captain .............................. |
| 12. | Nature of vessel (attached full description, including hull construction, main engine type and power, where and when built history of use) .................................... |
| 13. | Number of crew expected ................................................................. |
| 14. | Fish storage capacity for each storage method ............................................ |
| 15. | Operational base .......................................................................... |
| 16. | Fishing area ................................................................................ |
| I declare that the vessel described above is a local fishing vessel within the meaning of the Fisheries Act. |
| I understand that I am required to report any changes in the information contained in this form to the Chief Fisheries Officer within 7 days of the change. |
| .................................. | ........................ |
| Signature of Applicant | Date |
| Specify whether owner or charterer |
| Print name of applicant |
| CAUTION: Any licence issued on the basis of this application form is liable to cancellation if any of the information given in this application form is incorrect. |