card no.
expiry start security code - last 3 digits issue no. - Switch/
date date
on back
Maestro
Operator’s details
signature ..................................................................................................... date ....................................
cheque/postal order to “the Broads Authority”
cardholders name .................................................................... daytime tel no ..............................................
signature .............................................................................................. date ..............................................
please debit my Mastercard/Visa/Switch/Maestro/Amex
Payment
method
name ......................................................................................................... daytime tel no ........................................
address ....................................................................................................................................................................
................................................................................................................................................................................
email ........................................................................................................
Declaration
Vessel details see attached schedule
Small Passenger Boat Operator Licence £ 18.00
TOTAL £ 18.00
•
the particulars given above and on the attached schedule are correct to the best of my knowledge and belief
•
I have read and understood the conditions and agree to comply with any Authority or statutory conditions
•
the stability data provided to the Authority for vessels set out in the attached schedule is valid and no modifications
have been carried out which materially affect the stability of the vessels, as set out in the Small Passenger Boat
Licence Conditions (No. 7)
I apply for the issue of: a Small Passenger Boat Operator’s Licence and a Small Passenger Boat
Licence for boats (enter no. of licences)
on behalf of ................................................................................................................................................
I declare that:
Note: The licence fee of £5 for each Small Passenger Boat Licence is included in the amount set out on the toll account.
Please return this form and schedule
with your payment to:
Broads Authority Yare House
62-64 Thorpe Road Norwich NR1 1RY
Tel 01603 610734 Fax 01603 756069
Email broads@broads-authority.gov.uk
Re-Application for Small Passenger
Boat Operator and Vessel Licences
This application is being made under Section 94 of the Public Health
Acts Amendment Act 1907 and Section 40 of the Broads Authority Act 2009.
Please read the attached “Passenger boat” and “Small Passenger Boat Operator” conditions and guidance notes
1
before
completing this form. Note that the form need only be completed by operators of small passenger boats and that the
personal details given will only be used for official purposes. If you are not the Operator, please pass this form on.
click to sign
signature
click to edit
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click to sign
signature
click to edit
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