Certificate for international voyage application form Last updated: July 2017. This document is uncontrolled if printed, please refer to the Maritime New Zealand website for the latest version. About this form Use this form for an operator of a ship: that is under a Maritime Transport Operator Certificate (MTOC) less than 500 gross tons less than 45 metres in length undertaking an international, non-commercial relocation voyage applying for a new, o renewal of an existing, Certificate for International Voyage. To complete this application, you need to provide all of the information and documents we require. Note: You can only complete this form if you are the operator of the ship, either as an individual or as the authorised person to apply on behalf of a company. Page 1 of 16
1. Operator details All applicants must complete this section. Are you applying on behalf of a company? If you have ticked this box, please provide company name below. Complete all of these fields. Title (tick only one) Mr Mrs Miss Ms Other (please specify) Surname Given name(s) Nationality Place of birth City and country Date of birth Home phone Eg +64 1 234-5678 Mobile phone Eg +64 21 123-4567 Fax number Eg +64 1 234-6789 Email address Postal or delivery address City and country Postcode Preferred means of contact (tick only one) Email Post Phone Fax Page 2 of 16
2. Voyage information All applicants must complete this section. Complete all of these fields. 2.1 Ship details Ship name Gross tonnage Length overall (m) MTOC number MNZ/MSA number Official Number/ Registration Number Does your ship carry non-permanent Ballast Water? If you have ticked this box, you will need to apply for Ballast Water Management approval. Please refer to the Ballast Water Management guideline (maritimenz.govt.nz/ballast) 2.2 Voyage details Departure date (estimated) Arrival date (estimated) Departure port Arrival port 2.3 Purpose of voyage Please indicate what the purpose of the voyage is for: Relocating a ship into New Zealand from overseas for the first time after its purchase or construction If you have ticked this box, you need to complete section 3. Inbound voyage application. Relocating a ship from New Zealand to overseas, prior to returning to New Zealand If you have ticked this box, you need to complete section 4. Outbound voyage application. Page 3 of 16
3. Inbound voyage application Only complete this section if you are relocating a ship into New Zealand from overseas for the first time after its purchase or construction. Ship survey details Has a recognised surveyor confirmed the ship is fit to make the proposed voyage and meets applicable design and construction requirements set out in maritime rules for its class? No If you have ticked this box, your application will not be processed. Describe how the ship meets the design requirements e.g. conforms to a recognised classification society s standards; meets Australian state or territory marine authority requirements; or is designed using fundamental nautical structure design principles and analysis. Relocation voyage Will this be a one off relocation voyage? Attach a copy of the passage plan with this application. Note: Now go to 5. Communications and Navigation on page 8. Page 4 of 16
4. Outbound voyage application Only complete this section if you are relocating a ship from New Zealand to overseas, prior to returning to New Zealand. Ship survey details Has the vessel been assigned unlimited limits? No If you have ticked this box, attach a copy of the Certificate of Survey with this application form. If you have ticked this box, your application will only be processed if you do the all of the following: You apply for and are issued with an exemption from operating outside of your operating limits assigned under Maritime Rules Part 20 Operating Limits. A recognised surveyor issues a Certificate of Survey (which must be attached) confirming that the vessel is fit to undertake the proposed international voyage. The surveyor must hold a P1 or P1r recognition issued by Maritime New Zealand, endorsed for the construction material of the vessel. Alternatively, the surveyor issuing the certificate may hold recognition for a one-off relocation voyage valid from: TO You attach a copy of the Certificate of Survey, and the vessel s last out-of-water inspection report and the due date for the next out-of-water inspection (a certificate will not be issued for a period beyond this date. Other required certificates Indicate all required certificates that will be valid for the duration of the ship s operations overseas. Load line certificate (ships >24m+ in length) Expiry date: IOPP certificate (ships >400 GT or oil tankers > 150 GT) Expiry date: Other certificate Expiry date: Other certificate Expiry date: Page 5 of 16
4. Outbound voyage application (continued) Overseas commercial service Will the ship be going into commercial service while overseas? No Describe what the ship will be doing overseas e.g. used for the owner s pleasure; delivery voyage prior to sale to overseas buyer and change of flag etc. In the table below, outline the service(s), operating limits and timelines that the ship will be performing while operating overseas. Refer to the first row for an example: Relocation voyage Will this be a one off relocation voyage? Attach a copy of the passage plan with this application. Service Operating limits Estimated dates Start date End date Charter fishing XX nm off the coast of Tonga 21/4/2017 10/5/2017 Page 6 of 16
4. Outbound voyage application (continued) Other voyage details Will the ship be carrying passangers during the voyage? List the number of passengers: Return voyage details Have you planned a return voyage to New Zealand? Provide the following information: Estimated departure date: Estimated arrival date: Departure port: Arrival port: Page 7 of 16
5. Communications and navigation All applicants must complete this section. 5.1 Communications Tick what equipment will be carried on board this ship for the voyage: MH/HF Hand-held VHF Satellite phone Radio transponder VHF GPS Radar EPIRB Other Provide your radio details: MMSI No: Call sign: Is the ship < 24 metres? Attach a copy of the ship s Taupo Maritime Radio communications plan with this application form. Page 8 of 16
5. Communications and navigation (continued) Provide details for emergency contact(s): 1 st emergency contact Surname Given name(s) Phone Day time Eg +64 1 234-5678 Phone After hours Eg +64 1 234-5678 Mobile phone Eg +64 21 123-4567 Email address 2 nd emergency contact Surname Given name(s) Phone Day time Eg +64 1 234-5678 Phone After hours Eg +64 1 234-5678 Mobile phone Email address Eg +64 21 123-4567 5.2 Navigation List navigational charts to be carried aboard List sailing directions, lists of lights, tide tables, and notices to mariners to be carried aboard Page 9 of 16
6. Onboard equipment and stores All applicants must complete this section. 6.1 Safety equipment Provide details of the safety equipment that will be carried onboard the ship for this voyage. Equipment description Equipment type Survival craft Number carried Provide details of make, model, buoyancy levels, capacity, and expiry dates as appropriate. Lifejackets Lifebuoys Line throwing appliances Distress flares Immersion and anti-exposure suits Firefighting equipment Page 10 of 16
6. Onboard equipment and stores (continued) Provide details of any other safety equipment that will be carried onboard for this voyage. Equipment description Equipment type Number carried Provide details of make, model, buoyancy levels, capacity, and expiry dates as appropriate. Other equipment Fuel and water (Bunkers) Capacity Estimated usage Reserves Storage (if required) Page 11 of 16
6. Onboard equipment and stores (continued) 6.2 Medical stores Provide details of the scale of medical stores that will be carried onboard the ship for this voyage. For further information please refer to Maritime Rules Part 50: Medical Stores. maritimenz.govt.nz/rules Medical stores scale e.g 1, 2, 3 or 4 Page 12 of 16
7. Crewing All applicants must complete this section. Provide details of the ship s crew for the voyage. Crew member s role Full name Ticket held Page 13 of 16
8. When and how to apply All applicants must complete this section. 8.1 Fees and payment options The application fee is based on an hourly rate of NZ$218.00 which includes goods and services tax (GST). Refer to the MNZ website for more information about fees and how to pay your fees. maritimenz.govt.nz/fees maritimenz.govt.nz/howtopay Invoice MNZ will send you an invoice for the application fee and a receipt on payment. We will give you the payment reference details when we receive your application. You need to specify the name and address if the operator is a group of individuals, or if you want the invoice made out to a different entity or individual. Name to use on invoice Postal address City Country Postcode Payment Please tick to indicate how you want to pay the application fee. Online using a credit card or debit card Internet banking or bank deposit If you have ticked any of these boxes, provide the date you made the payment below: Cheque (made out to Maritime New Zealand) If you have ticked this box, attach your cheque with this application form. Page 14 of 16
8. When and how to apply (continued) 8.2 Where to send your application Send your completed form and the other documents required to MNZ by email, courier or post. If your application is incomplete, we will return all your application documents to you. Sending your application by email is preferred. Make sure the scanned copies of your documents are legible and of a good quality. Email your application to: operators@maritimenz.govt.nz Or Courier your application to: Operator Certification Maritime New Zealand 1 Grey Street Wellington 6011 NEW ZEALAND Or Post your application to: Operator Certification Maritime New Zealand PO Box 25620 Wellington 6146 NEW ZEALAND Page 15 of 16
9. Declaration All applicants must complete this section. I declare that the details provided on this form are true and correct. I confirm that any other documents sent with this form are true and genuine, and were given and signed by the persons whose names appear on them. Caution Providing false information or failing to disclose information relevant to Maritime New Zealand is an offence under section 406 of the Maritime Transport Act 1994. The penalty for this offence in the case of an individual is imprisonment for a term of up to 12 months or a fine of up to NZ$10,000. Your name Your signature Sign here Date Disclosure of personal information MNZ only discloses personal information to third parties when authorised by the individual or permitted by the Privacy Act 1993 or otherwise required or permitted by law. Accessing personal information You have the right to request access to personal information about you held by MNZ under the Privacy Act. You also have the right to request correction of any personal information held about you by MNZ. MNZ will take reasonable steps to correct that information and to ensure that the information we hold is correct. If you wish to access or correct personal information MNZ holds about you, please contact the MNZ Privacy Officer at PO Box 25620, Wellington 6146, or phone (04) 473 011. Page 16 of 16