EPIRB Registration Form

Please fill this form and make sure all your informations are correct before submission.

Reason for Registration *

Distress beacon details *

15 Character unique identifaction (hexadecimal ident.)

Checksum *

Manufacturer *

Model *

Beacon Unit Serial No. *

Beacon Battery expiry date

Owner/Operator Details

This is the owner information.

Full Name *

Phone Number *

+686

Email address *

Owner/Operator Home Address *

Emergency Contacts (Mandatory)

If possible, please supply up to 3 names (eg family, friend, neighbour); of which, one person must be contactable at all times. These people will be contacted if the beacon is activated.

Emergency Contact 1 Full Name *

Emergency Contact 1 Phone Number *

+686

Emergency Contact 2 Full Name *

Emergency Contact 2 Phone Number *

+686

Emergency Contact 3 Full Name *

Emergency Contact 3 Phone Number *

+686

RETAILER DETAILS

This is the place where you purchase your beacon. (see receipts for details)

Full Name *

Business Address *

Phone Number *

+686

Email Address *

MMSI *

Callsign *

DWT (tonnes) *

Registration No: *

Length (meters) *

Home Port *

Type of Vessel (owners description) *

Inmarsat No: *

Other Satellite mobile No: *

Type of Radio fitted/carried *

MF/HF

VHF

27MHz

Handheld VHF

Other Equipment *

AIS Class A

AIS Class B

Maximum No. of persons onboard. *

Number of LifeCrafts *

reCAPTCHA Checkbox *

Home

Our Services

Rules and Regulations

Universal Access

About Us

Login