Foreign Registry Form

Date:
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January 22,2019

CONTACT

*Name:

Address:

City

State/Province/Region

Zip Code

Country

Phones

*Work:

Home:

Cell:

*Email:

CORPORATE OWNERSHIP

If your boat is owned by a corporation, please provide us with the following:

Corporate Name:

Address

City

Province/Region

Zip Code

Country

Nationality of Corporation:

Is the Corporation in good standing with all government and Agent fees paid and current.

Please Provide a copy of the Certificate of Incorporation or Good Standing (New England Marine will have, if we set up Co.)

CORPORATE OFFICERS:

ADDRESS

President:  

Sec/Clerk:  

Treasurer:  

Director:  

Director:  

Shareholder:  

% Ownership:

Shareholder:  

% Ownership:

Boat Data

Current Name of Vessel:

Current Hailing Port or Port of Reg:

Registry Number/Official Number:

Name of Current Owner:

Address of Owner:

Contact Phone for Owner:

Please Provide a copy of the Certificate of Registry or Documentation

Boat Builder:     Model:

• Power
• Sail
• Mono.
• Catamaran
• Trimaran

Length Beam Hull Depth

Engine Make

HP

• GAS
• DSL

Location of the vessel:    

VESSEL TO BE USED SOLELY FOR PLEASURE

Proposed Name for Vessel:

Captain's Name:

Place of Birth:

Date of Birth:

TRANSMITTING EQUIPMENT:

Security Code: