South Pacific Avionics - 406 MHz ELT Registration Form

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406 MHz ELT Registration Form

406 MHz ELT/PLB/EIPRB On-Line Registration Form
Reason for Registration.
New Registration Updated Information Replacement Beacon	(e.g. Change of address or new owner)
	Reason for replacement
Beacon Details.
Make:
Model:
15 digit Hex ID:	If Known (We will complete this for new registrations)
Type of Beacon.
ELT EPIRB PLB	Automatic Activation Manual Activation
No. of other beacons installed:
Use of Beacon.
Aviation Marine Land	Where use is land, please describe the type of use in more detail. i.e. Tramping, Hunting, Kayaking, 4 wheel driving etc

Owner Operator Details.
Name:
Postal Address:
Home Phone:
Work Phone:
Fax:	(Maritime NZ will fax you a confirmation of registration if you enter a fax number here)
Mobile:
E-Mail:	(Maritime NZ will email you a confirmation of registration if you enter a valid email here)

24 Hour Contacts.	Please supply the names and phone numbers of up to 3 people, they should be contactable at all times. These people will be contacted if the beacon is activated.
Contact Name 1.
Name:
Home Phone:
Work Phone:
Mobile Phone:
Contact Name 2.
Name:
Home Phone:
Work Phone:
Mobile Phone:
Contact Name 3.
Name:
Home Phone:
Work Phone:
Mobile Phone:

Aircraft Details:	(These fields are for Aircraft use only)
Registration Mark :
Make and Model :
ICAO Abreviation (if known) :
Mobile or Satellite Phone:	Only enter the number for the phone which is normally installed or used in the aircaft (if any)

Vessel Details:	(These fields are for Marine use only)
Name :
Type:
Call Sign :
MMSI:
DWT	Tonnes
Length:	Meters
Home Port:
Type of Vessel:	Owners Description
Inmarsat Phone:	If Installed
Other Satellite or Mobile Phone:	If Installed
Types of Radios Installed:

Special Instructions: Enter any special instructions that you think might help us with the registration.
Email for corespondence: If different from owner/operator's email above.

Copyright © 2005 South Pacific Avionics Ltd. All rights reserved