Ministère en charge des douanes Ministère en charge des transports Application for registration under the French flag of a commercial vessel fishing vessel Articles 219 et 219 bis of the customs code Article L5112-1-1 of transport code N 15896*01 1. Applicant, shipowner legal representative authorised representative (if buyer or owner) of the applicant E-mail SIREN number Shipowner s SPR number A single shipowner or co-ownership (see annex on co-ownership) 2. Applies for 1 - Registration of a new ship 2 - Registration of an existing ship 3. Details of the ship Ship type (1) OMI number (if applicable) Nom (if existing ship) CFR number (fishing vessels) Current flag Current registration number Ship having a reserved name and registration number Under name Registration number Or ship without a reserved name and registration number Name remains or proposed name Name 1 Name 2 Name 3 Statement of mortgage Ship mortgage yes no If yes, in the mortgage registry office of (1) as defined in decree 84-810 of 30 august 1984 relating to the safety of life, the vessel s habitability and the pollution prevention..
4. Ship particulars Length overall (m) Hull length (2) Load line length (1) Maximum width Ship builder Year of build Main engine manufacturer Main engine number Total propulsive power (kw) Auxiliaries engines number Planned date for sea trial (according to circumstance) Classification society (according to circumstance Contact (1) As defined by article 2.8 of LL66 convention or ITC 69 convention. (2) In accordance with ISO 8666, for pleasure yachts of less than 24 m solely. Deadweight (tons) Gross tonnage (UMS) Keel laying date Main engine build country Engine type (internal combustion, diesel-electric, other) Total power auxiliaries Planned date for delivery (according to circumstance) 5. Owner or buyer (if different from applicant) And, if applicable, its permanent 6. Charterer and sub-charterer (if applicable) Chaterer And, if applicable, its permanent
Bareboat charter party from to : To : Sub-charterer charter party from : To : 7. Nautical management contract (if applicable) Manager Fisrt name And, its permanent Nautical management contract from to : To : 8. Other contracts and observations (for inscription on certificate of registry, if applicable) 9. Supporting documents For any application Power of attorney of representative and/or signatories (if signatory is no legal representative) Kbis extract not older than 3 months or certificate of incorporation of the shipowner Certificate of mortgage Certificate of flag deletion or suspension (if applicable) Sale contract or leasing contract with a buying option (if applicable) Co-ownership agreement (if applicable) Charter(s) party (if registration of charter party) Management contract (if applicable) Tonnage certificate (if applicable) Certificate of deletion of the previous flag State (if applicable) Custom declaration (if vessel is from non-eu countries) Asbestos free certificate (if applicable) issued by the shipyard or a recognised classification society
if application for entry into the fleet is in the framework of : Shipbuilding contract (duplicate) Proof of delivery Cession agreement (if transfer of ownership) Bareboat charter party Kbis extract not older than 3 months of the charterer or certificate of incorporation of the bareboat charterer Nautical management contract Kbis extract not older than 3 months of the manager a new ship an existing ship a bareboat charter party (Art 219. I.2 E or 219bis. I. 2 E of the customs code) a nautical management contract (Art 219. I.2 F of the customs code) 10. Commitment and signature I certify that the above information is true In : On : Applicant s signature French law n 78-17 of 6 janvier 1978 relating to information technology, files and civil liberties applies to individual-related data required on this form. It guarantees a right of access and rectification for this data with the relevant authority to which the application is made.
Annex on co-ownership (to fill in if the box co-ownership is checked in 1.) Co-ownership 1 Co-ownership 2 Co-ownership 3 Use a separate sheet if necessary