Licence Application and Authorisation for Port Activity and Exclusive Economic Zone (EEZ) A brief description of the form or Application to be filled out here. Vessel Name Vessel Use / Endorsement* Pleasure Commercial Official Number* Confirm Official Number* This Application is a(n):* ORIGINAL/PREMIÈRE DEMANDE AMENDMENT/MODIFICATIF Contact InformationName First Last Email* Enter Email Confirm Email Phone*Details of Vessel/Description du navireName of Vessel/Nom du navire: Type of Vessel/ Sorte de navire : Side number/ Numéro de coque: Country and Port of Registry/ Pays et Port d’immatriculation: Registered Number/ Numéro d’immatriculations Canadian Licence Number/No. du permis canadienne: Number of Officers in Crew? Membres d’équipage ( Officiers )Number of Seamen in Crew? Membres d’équipage ( Matelots )Number of other members in crew? Membres d’équipage ( Autres )Radio Call Sign/ Indicatif radio: Calling Frequency Working Frequency Year built/ Anné de construction: Where Built/Lieu de construction: Gross Tonnage/Jauge brute: Registered Net Tonnage/ Jauge nette au registre: Overall length of vessel/ Longueur total du navire Hull Material/ Matériaux Colour of Vessel Hull- Wheelhouse/Couleur de le la coque Owner’s Name and Address/ Nom et adresse du propriétaire: Master’s Name and Address/ Nom et adresse du capitaine: Charter’s Name, if applicable/ Nom de l’affréteur, s’il y a lieu: Observer Name/ Nom de l’observateur: Designated representative in Canada/Représentant au Canada: Address/Adresse Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone/ Téléphone: Cell phone/cellulaire: Fax/ Facsimile: E-mail/couriel: Reason for Visit to Port, EEZ Access/Raison de la visite au port, accès au ZEEReason for port visit Shore leave, obtaining provisions (including bait), and/or repairs (State particulars) /Permission à terre, avitaillement et/ou réparations (Donner des précisions) Crew exchange/Changement d’équipage Landing/Reloading/Transhipping any Equipment other than Fishing Gear of the Vessel (State Particulars)/ (Donner des precisions) Loading/offloading any fishing equipment and/or fishing gear (State particulars) /Chargement/déchargement de matériel et/ou d’engins de pêche (Donner des précisions) Offloading Fish (State particulars) / Déchargement de poisson (Donner des précisions) Transhipping fish at sea or port (State particulars) /Chargement de poisson (Donner des précisions) Fishing in Canadian EEZ(State particulars) Processing at sea (State particulars) Other Activities Describe # Embarking/Nombre embarquant # Disembarking/Nombre débarquant Name of vessel Side number Species/Espèce Product Form/ Forme du produit Quantity(t)/Quantité (t) Area fished/ Port of offloading/Port de déchargement Plant/Destination Species/Espèce Product Form/ Forme du produit Quantity(t)/Quantité (t) Area fished/ Port or Vessel of offloading/ Port ou navire de déchargement Plant/Destination Species/Espèce Quota/Allocation Fishing Area/Zone de pêche Approximate Dates/Dates Approximatives (From /De – To/À) Species/Espèce Product Form/ Forme du produit Quantity(t)/Quantité (t) Area fished/ Supplier Port of offloading Canadian Port/Port Canadian Pier or berth, if applicable/Quai ou poste d’amarrage, s’il y a lieu Date of Entry/Date d’arrivée Time Requested (UTC)/ Heure de la demande (TUC) Estimated Date of Departure, Remarks/ Estimation de la date du départ, remarques Time of Departurre/ Heure du départ Date Inspected/ Date d’inspection Inspection Number/ Numéro d’inspection Next Area to be Fished/ Prochaine region de pêche Additional InformationFormer Vessel Names Former Countries of Registry Names of Former Vessel Owners Was the vessel/ master/owner the recipient of any citation/ infringement related to fisheries activities? Provide details, including dates: Is vessel authorized by relevant authority to engage in fisheries activities? Please provide details and attach a copy of the authorization (e.g. fishing licence).Areas, scope and Duration of Licence State Issuing Licence Species and Quota authorized Fishing Gear authorized Transshipment record (where applicable) Trip Information:Date Trip Commenced Areas Fished Product Form (Fresh frozen etc.) Ports Visited Date Fishing Ended Species Application Fee Price: RENEWAL ADVANCED PAYMENT OPTION No Additional Years 2 year renewal 3 year renewal 4 year renewal 5 year renewal Total $0.00 Consent* I agreeI CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.Signer is:* Representative / Représentant Master / Capitaine Name, Representative / Signature du représentant* Type your full name to sign this secure webformName, Master/ Signature du capitaine* Type your full name to sign this secure webformSignature*CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER) Date MM slash DD slash YYYY Authorization* I agreeI agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected permits. I understand that my application will be processed in the order in which it is received by Commercial Fishing Permits Center, a private fee-for-service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Commercial Fishing Permits Center's no refund policy. I understand that submitting another application for a license or permit will supersede the current/pending application for that license or permit. I understand that Commercial Fishing Permits Center does not issue or sell any licenses or permits.Credit Card Having Trouble with your card? My card information is not workingCheck this box to move forward without your Credit Card.By clicking submit you agree to these Terms and Conditions and the above authorization of payment.