Transmission on Death/Bankruptcy

Official number

Name of vessel

Port of registry

INDIVIDUAL

Signature

DECLARED BEFORE ME AT

Signature

Date Declaration signed

Name and title

Address

CORPORATION

I

state that I have authority to bind

I also state

is the name of a corporation which legally exists at the date of this Declaration:

as per the laws of Canada; OR
as per the laws of (province/state)

Name of province/state

This Declaration must be signed by any Officer or Director of the corporation who has the authority to bind the corporation. Pursuant to Sections 51(2) and 75.01(2) of the Canada Shipping Act, 2001 applicants may be required to provide additional information as requested by the Chief Registrar.
I understand that it is an offence for a person to knowingly make a false or misleading statement in writing and that the penalty can be a fine or imprisonment or both if found guilty in a court of law (Section 37 of the Canada Shipping Act, 2001).

Signature of Officer or Director

DECLARED BEFORE ME AT

Signature

Date Declaration signed

Name and title

Address

INDIAN BAND

Name of Indian Band

Signature

Name of person signing above

DECLARED BEFORE ME AT

Signature

Date Declaration signed

Name and title

Address

Contact Information

First Name*

Last Name*

Telephone Number*

Facsimile Number

Email*

Enter Email Confirm Email

APPLICATION FOR TRANSMISSION DEATH/BANKRUPTCY

Price:

APPLICATION FOR TRANSMISSION DEATH/BANKRUPTCY

Price:

Please select any additional services you wish to have processed

Priority Request/Rush Processing

Priority Request/Rush Processing

Price:

Total

$ 375.00 CAD

Authorization*

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected Transport Canada documents. I understand that my application will be processed in the order in which it is received by National Vessel Registry Center Corp, a third-party fee for service company. I understand that application and processing fees are non-refundable as per National Vessel Registry Center Corp's no refund policy.

Credit Card*

Card Details

Cardholder Name

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Billing Address

Address*

Street Address Address Line 2 City ZIP / Postal Code (required for Canadian [A1A 1A1] and US [#####] only)

State/Province/Region*

Other*

Country*

Is your shipping address different from the one above?

Shipping Address

Address*

Street Address Address Line 2 City ZIP / Postal Code (required for Canadian [A1A 1A1] and US [#####] only)

State/Province/Region*

Other*

Country

By clicking submit you agree to these Terms and Conditions.

DECLARATION OF TRANSMISSION

Step 1 of 2

DETAILS OF TRANSMISSION - DECLARE AS FOLLOWS (select one)

INDIVIDUAL

CORPORATION

INDIAN BAND

Contact Information

Billing Address

Shipping Address