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Date: |
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CONTACT |
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Name: |
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Address |
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City |
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State/Province/Region |
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Zip Code |
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Country |
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Phones |
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CORPORATE
OWNERSHIP |
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If your boat is owned by a corporation, please
provide us with the following: |
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Corporate Name: |
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Address |
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City |
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Province/Region |
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Zip Code |
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Country |
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Nationality of Corporation: |
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Is the Corporation in good standing with all
government and Agent fees paid |
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and current. |
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Please Provide a copy of the
Certificate of Incorporation or |
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Good Standing (New England Marine will have, if
we set up Co.) |
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CORPORATE
OFFICERS: |
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ADDRESS |
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President: |
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Sec/Clerk: |
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Treasurer: |
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Director: |
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Director: |
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Shareholder: |
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% Ownership: |
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Shareholder: |
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% Ownership: |
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Boat
Data |
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Current Name of Vessel: |
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Current Hailing Port or Port of Reg: |
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Registry Number/Official Number: |
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Name of Current Owner: |
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Address of Owner: |
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Contact Phone for Owner: |
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PLease Provide a copy of the
Certificate of Registry or Documentation |
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Boat Builder: Model: |
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Power Sail Mono.
Catamaran
Trimaran |
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Length
Beam Hull Depth |
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Engine Make HP GAS DSL |
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Location of the vessel: |
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VESSEL TO BE USED SOLELY FOR
PLEASURE |
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Proposed Name for Vessel: |
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Captain's Name:: |
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Place of Birth: Date of
Birth: |
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