Boatyard Vessel Registration - Queenscliff Harbour

Applicant's Name *

First

Last

Owners' Name

First

Last

If different from above

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Alternative Phone

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone

Vessel Details

Vessel Name &/or Registration Number *

Design *

Rig

Fuel

Year

LOA *

metres

Beam *

metres

Draft *

metres

Weight *

metres

Motor

Horsepower

Type of Construction *

Power

Brief Description of Works Intended *

Vessel Images

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

If you have an out of water image please upload to assist us in arranging your liftout. PLEASE NOTE: Only JPG, PNG, GIF and PDF files up to 2Mb are allowed.

Preferred Date for Vessel Lift out of Water

Preferred Date for Vessel Return to Water

Insurance *

I certify

I certify that I have a minimum of $10 million public liability insurance for the above vessel and a current certificate of currency is attached below.

Certificate of Currency *

Drag & Drop Files, Choose Files to Upload

PLEASE NOTE: Only JPG, PNG, GIF and PDF files up to 2Mb are allowed.

Terms and Conditions *

I Agree

In consideration of Queenscliff Boatyard liftout and hardstand space for my/our use and occupation, I/we agree to pay the fees requested by Queenscliff Boatyard and comply with the and occupation, a copy of which I/we have read and understood boatyard conditions of use.

Additional Comments/Information