Official number	Ship’s name

Particulars of transmittor (registered owner)

Full name and address of owner(s)

Contact telephone number	*Email address (if any)

Particulars of transmittee(s) (new owner(s))

Full name	Address (see note 1)	Nationality (see note 2)	Basis for nationality claim (see note 3)	Number of shares
Birth Naturalisation Incorporation	/64
Birth Naturalisation Incorporation	/64
Birth Naturalisation Incorporation	/64
Birth Naturalisation Incorporation	/64

Contact telephone number	*Email address (if any)

Declaration

I / We hereby declare that to the best of my/our knowledge, the ship will not cease to be an Australian-owned ship by reason only of this transmission.

Date	Place

Signature of transmittee(s)	Signature of witness
If the transmittee 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

NOTES

The address must be: Residential address - for an individual; Registered office address - for a company; Principal place of business - for a statutory body or foreign company.

Nationality - if a body corporate, the country in which incorporated.

Basis for nationality claim - birth or naturalisation or incorporation.

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