Sch 6Forms

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