Instructions:
  1. Print out this form by clicking the print button on your browser.
  2. Fill out the form completely, by hand is fine.
  3. Fax the form to us at + (507) 269-2548.
  4. Make payment by wire transfer to our account, as follows:
  5. The Chase Manhattan Bank

    New York, New York

    ABA 021-000-021  (Within the United States)

    CHIP 002  (Out of the United States)

    SWIFT CHASUS 33

    In favor of

    Banco Continental De Panamá

    Panamá, Rep. de Panamá

    Cuenta  No.: 5447-39727

    For further credit to:

    Garibaldo Y Asociados

    Acct. No.:  01-14370-301

    OR

  6. Send certified check along with this form by courier to our address in Panama. 

Information Needed for a Vessel’s Enrollment into the

PANAMANIAN SHIP REGISTRY

              Please apply for the following vessel’s registration and radio license and advise Secnaves to instruct Panamanian Counsel ___________________ to issue the required temporary documents.   Please send by courier all documentation issued to the following address:

                                                                                                                      

 

1.      Vessel’s Name:                                                                         

2.      Vessel’s Previous Name:                                                        

3.      IMO Number:                                                                          

4.      Previous Nationality:                                                               

5.      Shipowner’s Name:                                                                  

Shipowner’s Address:                                                                   

                                                                                                          

6.      Type of Service (tanker, etc.):                                                  

7.      Hull Material:                                                                                       

8.      Shipyard:                                                                                              

9.      Year & Place of Construction:                                                 

10.       Length, Breadth & Depth (in Meters) :                                         

11.       Gross and Net Tonnage:                                                          

12.       Brand of Engine:                                                                      

13.       # and Type of Engines:                                                             

14.       # of Cylinders per Engine:                                                        

15.       Horsepower (in BHP) and Speed (in Knots) :                              

16.       Classification Society:                                                               

  1.   Radio Accounting Authority:                                                           

 

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