Western Australian Consolidated Regulations

PORTS AND HARBOURS REGULATIONS 1966 - FIFTH SCHEDULE

[r. 18(5)]

Country	Record
Britain	Certificate of British Registry. British Tonnage Certificate.
Panama	Ship’s Register. Certificado de Arqueo.
Liberia	Ship’s Register. Certificate of Measurement.
Belgium	Ship’s Register. Certificat de Jaugeage. (Tonnage Certificate)
Sweden	Ship’s Register. Internationelt Matbriv. (International Tonnage Certificate)
Netherlands	Ship’s Register. Internationale Meetbreef. (International Tonnage Certificate)
Italy	Ship’s Register. Certificato di Stazza.
India	Certificate of Indian Registry.
Singapore	Certificate of Singapore Registry.
Germany	Amtlich Belaubigter. Internationaler Schiffsmessbreef.
Indonesia	Ship’s Register — Certificate of Nationality.
Korea	Certificate of Vessel’s Nationality.
Japan	Certificate of Vessel’s Nationality.
Yugoslavia	Upisni List.
Argentina	Certificado de Matricula.
Greece	Certificate of Nationality. Certificate of Measurement.
China	Certificate of Vessel’s Nationality. Tonnage Certificate.
Russia	Ship’s Register.

        [Fifth Schedule inserted in Gazette 28 Aug 1981 p. 3575.]

Forms

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 PORTS AND HARBOURS REGULATIONS, become entitled to navigate a vessel into and out of the ports specified herein 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........

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EXECUTIVE DIRECTOR         SIGNATURE OF HOLDER

			PERSONAL PARTICULARS
	PASSPORT SIZE PHOTOGRAPH
NAME IN FULL ADDRESS DATE OF BIRTH PLACE			......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... ......................................................................................... .......................................... COUNTRY..........................
If found this certificate should be returned to:         Department of Marine and Harbours  3         Marine House         1 Essex Street         FREMANTLE WA 6160

PORTS AS TO WHICH CERTIFICATE APPLIES

PORT	CONDITIONS	NAME AND SIGNATURE OF OFFICER	DATE
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        [Form 1 inserted in Gazette 19 Jul 1991 p.3648-9.]

FORM 2

[r. 16J(1)]

PILOTAGE EXEMPTION RECORD BOOK

Port Visits					Medical Certificates
Port	Date & Time In	Date & Time Out	Name of Vessel	Pilot/Harbour Master Initials	Received	Next Due

        [Form 2 inserted in Gazette 19 Jul 1991 p. 3648-9.]