| Call sign: | ID for DSC (VHF): |
| Selcall No. for NBDP: NA | ID for DSC (MF/HF): |
| 1st ID for INMARSAT-B/ Fleet 77: | ID for DSC (MF): |
| 2nd ID for INMARSAT- B/ Fleet 77: ……………………. | 1st ID for INMARSAT-C: |
| ID for Satellite EPIRB: 419000154 | 2nd ID for INMARSART-C: |
| Note 1: Results of survey to be marked “Y” (Yes), “N” (No) or “N/A” (Not Applicable) |
| Note 2: Functional tests are to be verified for compliance with IMO performance standard. |
| Sea area in which vessel is certified to operate: A1 £; A1+A2 £; A1+A2+A3 R; A1+A2+A3+A4 £ (Reg. IV 12) | |
| Any other specific area: ………………………………………. | £ |
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