Ports and Harbours Regulations
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Schedule 6 — Forms
[Heading inserted: Gazette 4 Jun 2010 p. 2461.]
FORM 1
[r. 16H(1)]
PILOTAGE EXEMPTION CERTIFICATE
THIS IS TO CERTIFY THAT...............................................................................
whose signature appears below, has, in accordance with the provisions of the Shipping and Pilotage (Ports and Harbours) Regulations 1966, become entitled to navigate a vessel into and out of the pilotage areas specified in this Form without the services of a pilot and is EXEMPTED accordingly from the requirement to take on board a pilot.
This certificate is subject to the conditions specified in it.
Dated........................................................20........
............................................... ..............................................
EXECUTIVE DIRECTOR SIGNATURE OF HOLDER
- PERSONAL PARTICULARS
- PASSPORT SIZE PHOTOGRAPH
- NAME IN FULLADDRESSDATE OF BIRTHPLACE ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... COUNTRY..........................
- If found this certificate should be returned to: Department of Transport Marine House