Untitled Document

EXISTING VESSEL REGISTRATION RENEWAL

FORM 12

The Registering Authority

Kerala.

I, being the of an Inland Vessel hereby request that the said vessel be registered at the

I agree to pay such fees as may be leviable under the Rules.

Particulars in respect of the said vessel are as under:-

Registered Year of Existing Vessel *

Carefully Enter Registered year of your vessel...Further processing of vessel based on this year.

Carefully Enter Register Number of your vessel...Further processing of vessel based on this number.

Name of Owner *

Address of Owner *

Occupation

Occupation Address

E-mail Id *

Mobile Number *

Desired Username *

Name of Vessel *

Category of Vessel *

Sub Category of Vessel

Survey Certificate No

Vesseltype *

Year of Completion

Sub Vessel Type

ENGINE DETAILS

Number of Sets

Whether Inboard or Outboard

a) BHP

b) Name of Manufacture

c) Brand of Manufacture

d) Model No. for Engine

e) Type of Engine

f)Diameter of Propulsion shaft(in cm).

g) Material of Propulsion Shaft

h) Type of Gear

i) Number of Gears

DETAILS OF INSURANCE CERTIFICATE

Name of Insurance Company

Insurance Number *

Insurance Date

Date of Expiry of Insurance *

Payment Type *

DD DETAILS
DD Amount *		DD NO: *
DD Date *		Payable At *
Bank Details Payable at in favour of *		Port of Registry *
Select District *		Favour who *

CHALLAN DETAILS
Challan Amount		Seq.No:
Seq Date		Name of Treasury

Date of Last Survey*

Nature of Survey(state if survey in dry dock is required)

Statement by the owner that the provisions of the Act and these rules have been complied with

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Duplicate of the certificate of survey

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DD receipt evidencing payment of such fees as specified in the schedule for the registration of the vessel

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Copy of the 3rd party insurance certificate of the vessel duly attested

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DECLARATION OF OWNERSHIP

I, subject of the state of residing permanently at/ having principal place of business at do hereby declare that (name) was built at in the year and was purchased by me on for Rupees and wish to have registered it in my name at the port of and that I am the sole owner of the same. I further declare that the vessel is intended to ply in the port of

Owner

Declaration of Ownership