EPIRB Hire – Register your Emergency Contacts

Account No.(Required)
Please enter your Account No. given on your Hire Agreement Example: HET000
Contact Name(Required)
Please give the Full Name of Hirer given on the Hire Agreement
First Name Surname
Business/Company Name
Only required if your hire is under a business/company name
Hire Contract Number(Required)
Please enter the hire contract number given on your Hire Agreement. Example: 0000012345
EPIRB No.(Required)
This is itemised on your Hire Agreement and both the EPIRB and packaging is labelled. Example: EPIRB001
EPIRB HEX No.(Required)
Please enter the HEX No. given at the end of the Item Description on your Hire Agreement. Example: 1D0E6C1222FFBFF
Hire Dates
Please enter the Hire Start Date given on your Hire Agreement
Hire Start Date(Required)
DD slash MM slash YYYY
Hire End Date(Required)
DD slash MM slash YYYY
Where will the EPIRB be carried(Required)
Example: UK
Beacon Use(Required)
Please enter the activity that is requiring an emergency beacon
Additional Comments
Please enter any more information about you planned activities, for example cruising area, and any other information you think is relevant.
Vessels Details
Vessel Name(Required)
MMSI(Required)
Call Sign(Required)
Radio Communications(Required)
Please detail radio communications equipment on board EG. VHF, VHF/DSC, Inmarsat C, Satellite telephone numbers, etc
Vessel Type(Required)
Maximum Number of Persons on Board(Required)
Your Contact Details
Your Name(Required)
Prefix First Last
Email(Required)
Enter Email Confirm Email
Address
Address Line 1 Address Line 2 Town/City County Post Code Country
Primary Phone No.(Required)
Secondary Phone No.
Your Emergency Contacts
Please give two contacts in case we need to give them to the emergency services.
Emergency Contact 1(Required)
Prefix First Last
Contact Phone No.(Required)
Emergency Contact 2(Required)
Prefix First Last
Contact Phone No.(Required)
IMPORTANT PLEASE READ
Please Read before submitting this form(Required)
I agree as per the EPIRB Hire Agreement, that I will notify Suffolk Marine Safety of any changes once this form has been submitted and throughout the duration of my hire of the EPIRB.
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How did you hear about us?(Required)
It helps us to know how our customers find us, please select how you found out about our services.
Can we stay in touch with any news or offers(Required)
We promise not to fill your inbox.
- Yes please
- No thank you
Email
This field is for validation purposes and should be left unchanged.

Hire Dates

Vessels Details

Your Contact Details

Your Emergency Contacts

IMPORTANT PLEASE READ

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