LRIT procedures

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					                                                                                                                                                                                                                           Code:     AMTS-PA-F-01
                                                                                                                                                                                                                         Version:         1.1
                                                                                                                                                                                                                           Date:        Jan-10
                                                                                                              LRIT TEST REQUEST FORM                                                                                       Page:         1 of 1



Please fill out completely in order to performance LRIT Conformance Test as per MSC.1/Circ. 1307 on the following Panama Flagged vessels under our ownership or management:

                                                        VESSEL DETAILS:                                                                                                 DESIGNATED LRIT TERMINAL DETAILS:

                                                                                                                                                                                                                                     Equipment is
                                                                                           Nav Area                                                                                                                              powered from main
                                                                                       indicated in SSL                                                                                                                             and emergency
                                                                                        (Please attach                                                                                                                           energy sources. (Non-
                                                                                            copy of        Date Next     MANUFACTUR                  Equipment Serial   Inmarsat Serial   Inmarsat Mobile                          Inmarsat C only)
           SHIP NAME                 CALL SIGN   MMSI     IMO Number      Gross Tons      document)       Radio Survey       ER       MODEL              Number          Number (ISN)      Number (IMN)     SSAS Terminal YES/NO       YES/NO




                                                                                                            COMPANY INFORMATION
Name of Company/Requester
Street Address
City, State, Zip
Main Telephone number (code area+ number)
Main fax number (code area+ number)
Company World Wide Web address
Applicant Name Cellular (code area+
Direct Telephone/
number)
City
                                                                                                              BILLING INFORMATION
Name of Business / Requester
Street Address
City, State, Zip
Contact Information
Payment Sender Name*
Method of reciept invoice (fax, email, post,
courier)
Post address:
International Courier:
International Courier Account N°
Special Instructions (If any)
24-Hours Telephone number (code area+                                                                        EMERGENCY CONTACTS
number)
24-Hours Point of contact (code area+ number)
Alternative Point of contact
Alternative Point of contact telephone
number
24-Hours E-mial address


                                                                                             Apartado 0816-02168, Panama, Republic of Panama


                                                                                             activations@panama-lrit.com / www.panama-lrit.com

				
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posted:8/27/2011
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