PART 4 - Canadian Coast Guard
PART 4 - Canadian Coast Guard
PART 4 - Canadian Coast Guard
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APPLICATION for a RADIO INSPECTION of a COMPULSORILY FITTED VESSEL<br />
Name of Vessel Port of Registry MMSI Call Sign<br />
Gross Tonnage Length Official Number IMO Number<br />
Agent: Name, Address, Telephone Number<br />
Check if appropriate to this inspection<br />
New vessel or first inspection?<br />
Change of Voyage?<br />
Change of Certificate Type?<br />
Check appropriate Vessel type<br />
Cargo<br />
Tanker<br />
Government Search & Rescue<br />
Drilling Unit<br />
Oil and Gas Standby Vessel<br />
Fishing<br />
Fish Processing<br />
Passenger<br />
Tow-Boat<br />
Radio Services Representative: Name & Telephone Number<br />
Inspection Requested - Date:<br />
Time:<br />
Port, dock or quay, at which survey is to be conducted<br />
Application is hereby made for a radio inspection for the ship indicated above in accordance with <strong>Canadian</strong> Law and International Convention or<br />
Treaty as applicable. If after inspection the radio apparatus is found to comply with the requirements, it is requested that the following<br />
document(s) be issued.<br />
Please check all appropriate boxes.<br />
RADIO INSPECTION CERTIFICATE (Sea <strong>Coast</strong> of Canada)<br />
RADIO INSPECTION CERTIFICATE (Great Lakes Basin)<br />
CARGO SHIP RADIO SAFETY CERTIFICATE (SOLAS)<br />
Renewal Survey<br />
Periodical Survey<br />
REPORT OF INSPECTION concerning a radio installation on board a passenger ship engaged in international voyages.<br />
LETTER OF CERTIFICATION concerning a radio installation on board a Non-Convention cargo ship to allow Customs Clearance for an<br />
international voyage.<br />
VOYAGE TYPE:<br />
Home Trade<br />
I, II, III or IV<br />
Minor Waters I or<br />
II<br />
Inland Waters I or<br />
II<br />
Sea Area: A1 A2 A3 A4<br />
Foreign<br />
International<br />
CONDITIONS OF INSPECTION:<br />
a) Transport Canada is responsible for the conduct of ship radio inspections pursuant to the Canada Shipping Act. The Minister of Transport<br />
has appointed <strong>Canadian</strong> <strong>Coast</strong> <strong>Guard</strong> Radio Inspectors to carry out radio inspections.<br />
b) An application for inspection shall be submitted to the <strong>Canadian</strong> <strong>Coast</strong> <strong>Guard</strong> office nearest to the desired port of inspection at least 3<br />
days in advance of inspection date.<br />
c) When an inspection is requested of a ship registered elsewhere than in Canada, the application must be accompanied by a letter from the<br />
Consul or another official representative of the Administration concerned in accordance with Regulation 13, Chapter 1, SOLAS 1974, or<br />
Protocol 1988.<br />
d) The ship’s electrical power shall be available and a person with authority to operate the radio station shall be on board at the date and time<br />
determined for the inspection.<br />
e) Fees are payable as outlined in the Ship Radio Inspection Fees Regulations (SRIFR)<br />
_______________________ ________________________________________<br />
Date<br />
Signature of Agent or Master<br />
76-000-000-PF-JP-001 (12-2004) 82-0643<br />
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