Applicant’s details

Name
Address
Phone number
Fax number
Email address (if any)
Name of contact person

Ship’s details

Name
Official number or, if unknown, any other information that may help identify the ship

Required method of transmission

Email: sro@amsa.gov.au

Post: Shipping Registration Office, GPO Box 2181, Canberra, ACT, 2601

Payment Details

Method of payment

Direct deposit Cheque Money order Credit card	Note: Please reference ship’s/person’s name on the deposit and forward a copy of the deposit receipt to process request. Account Name: Australian Maritime Safety Authority Bank: Westpac Account No: 216888 Branch No: 032-778 Branch: Westfield Shopping Centre, Belconnen ACT 2617 International Swift Code: WPACAU2S

Mastercard Visa

Full name of cardholder
Card number
Expiry date
Amount
Signature of cardholder
Date