Transcription of REGISTER ONLINE: www.cbr-rcb.ca OFFICIAL CANADIAN …
1 EPIRB MANUFACTURER MODEL #BEACON SERIAL NOCHECKSUMDO YOU CURRENTLY HAVE ANY CANADIAN BEACONS ALREADY REGISTERED IN OUR DATABASE?YNNEWEPRIB REGISTRATIONCHANGE OF EPIRB OWNERSHIPEPIRB REGISTRATION UPDATEREPLACEMENT BEACON IF APPLICABLE, ENTER 15-DIGIT HEX CODE FOR BEACON BEING REPLACEDSTREET ADDRESSHOMEWORKCELLCITY PROVINCEFAXPOSTAL CODE COUNTRYOTHEREMAIL ADDRESSRECREATIONALMILITARYFERRYTANKERSA ILCOMMERCIALGOVERNMENT (FEDERAL)TUGPLEASURE CRAFTINFLATABLEADDITIONAL: (troller, ketch, etc)GOVERNMENT (PROV/TERRITORY)SAR CARGOFISHINGVESSEL NAME (AS IT APPEARS IN REGISTRATION)INBOARD OUTBOARDCOMBOOTHERHOME PORT (CITY/PROVINCE/MARINA)REGISTRATION OFFICIAL #LENGTH (m) :VHF/FMMFHF/SSB# OF MASTSHULL TYPE/MATERIALMAX PERSONS CALL SIGN SAT / IMMARSATHULL COLOUR STRUCTURE COLOUR ON BOARD CELL# MMSIDISTINCTIVE FEATURES (DECALS, STRIPING) PRIMARY CONTACTCONTACT 2 CONTACT 3 NAMERELATIONSHIP / TITLEHOME PHONECELL PHONEWORK PHONE**Your emergency contacts should not be aboard the vessel.
2 Please include contacts who are available to be reached 24 hours a day as they will be contactedshould this beacon activate**SIGNATUREDATEREGISTER ONLINE: OFFICIAL CANADIAN 406 MHz EPIRB REGISTRATION FORM - CANADIAN CODED BEACONS ONLYIS THIS A PRIVATE REGISTRATION? OWNER NAME: BEACON HEXCODE ( UIN ) [PREFIX 278, 279, A78 OR A79]PLEASE SPECIFY TYPE OF EPIRB REGISTRATIONVESSEL OWNER / OPERATOR INFORMATIONVESSEL INFORMATIONIS THIS A COMMERICIAL REGISTRATION ? COMPANY / OPERATOR : AUTHORIZED REPRESENTATIVE / CONTACT PERSON (other than / on behalf of owner) : MAILING ADDRESSOWNER TELEPHONE INFORMATION (INCLUDE AREA CODE) REGISTER ONLINE: FAX OR MAIL: CANADIAN Beacon Registry - CFB Trenton, PO Box 1000 Stn Forces, Astra, ON, K0K 3W0 TEL: 1-877-406-SOS1(7671) FAX: 1-877-406-FAX8(3298) EMAIL: DESCRIPTIONPOWER/MOTORCOMMUNICATION EQUIPMENT INFORMATIONEMERGENCY /SURVIVAL EQUIPMENT (ie LIFE RAFT / SURVIVAL SUITS ETC)**REQUIRED EMERGENCY CONTACT INFORMATION**
