Vessel Survey
APPLICATION FORM
Number: FM 0269
Issue: 05
Date: 10.05.18
VESSEL SURVEY
Marine House, Denton Wharf
Mark Lane, Gravesend
Kent DA12 2PL
T: +44 (0) 1474 562200
E: vesselsurvey@pla.co.uk
Website: www.pla.co.uk
COMPANY NAME:
CONTACT NAME:
ADDRESS:
MOBILE TEL. No:
PLA OWNER No.
(if allocated):
LANDLINE TEL. No:
CONTACT EMAIL:
APPLICATION FOR THE SURVEY OF VESSELS
I hereby request survey of the following vessel(s):
PLA Vessel
Number
(if allocated)
Type Of Vessel
Dimensions (In Metres)
Length Beam Draught Tonnage
(GT)
Information provided on this form will be retained by the Port of London Authority for the purposes
of Vessel Survey and in accordance with all applicable Data Protection Regulations
I AM THE OWNER / OPERATOR * (Delete as appropriate)
PROPOSED PLACE OF SURVEY:
AREA OF OPERATION - FROM :
TO:
PRINT NAME:
SIGNATURE:
POSITION IN COMPANY:
COMPANY REGISTERED No.
DATE:
Owner