Official number	Ship’s name

Proposed name for the ship (in order of preference)

Note: names that may not be approved are:

names that are the same as or similar to names of registered ships or of ships about to be registered,

blasphemous or otherwise offensive names,

names of members of the Royal family,

names that falsely suggest a connection with the Royal family, or international, national, state or local government bodies,

names that include prefixes capable of indicating a type of ship (e.g. MV, FV, SS).

*Full name and address of owner(s)

*Contact telephone number	*Email address (if any)

NOTE

Please forward certificate of registration along with the application for change of name of registered ship.

Signature

I hereby apply for approval to change the name of the ship described above.

Date	Place

Signature of owner(s) or registered agent	Signature of witness
If the applicant is a corporation, the document may be formally executed under the corporate seal. Alternatively, an officer of the corporation may sign it, endorse it with a legible statement of his/her name and designation and have the signature witnessed.
Name of witness
Address of witness

Except where indicated by * the collection of information requested in this form is either required or authorised by the Shipping Registration Act 1981 (the Act). It will be used for purposes related to the Act (including possible overseas disclosure) and will be available for public search in circumstances as the Act requires. It may be made available to government agencies for statistical and administrative purposes. Failure to provide the information will result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information or how to make a privacy complaint, visit www.amsa.gov.au/privacy-policy