Form FMC-78 NVOCC Service Arrangement Registration

Instructions For Form FMC-78
Completed Form FMC-78 should be sent by mail or facsimile to:
Federal Maritime Commission
Bureau of Trade Analysis
800 N. Capitol Street, NW
Washington, DC 20573-0001
Fax (202) 523-5867

Line 1. Organization Number. This is the same as the Regulated Persons Index ("RPI") Number.
Line 2. Registrant. Provide the full name of the firm or individual registering for the automated NSA
filing system and any trade names. The Registrant's name should match the corporate charter or
business license, etc. The Registrant's name cannot be changed without submission of an amended
registration form.
Line 3. FMC License Number. Provide name of Registrant as licensed by the Commission and date
of the effectiveness of that license. If Registrant is a bonded but unlicensed foreign-based NVOCC
operating pursuant to Commission's regulations at 46 C.F.R. § 515.3, indicate the name and address
of the agent for service of process as required by 46 C.F.R. § 515.24. The name and address of the
agent for service of process must be the same as that appearing in the NVOCC's tariff, as provided
by 46 C.F.R. § 520.11 (b).
Line 4. Registration. Indicate whether this is the initial (first time) registration or an amendment to an
existing NSA registration.
Line 5. Address of Headquarters Office. The complete street address of the Registrant's principal
place of business should be shown in addition to a post office box (if any). Post office box alone is
insufficient. Provide the Registrant's Federal Taxpayer Identification Number, if any.
Line 6. Mailing Address (if different). Provide the mailing address only if it differs from the
headquarters address listed in Line 5. Show the street address as well as any post office box. This is
the address to which the Registrant's log-on I.D. and password will be mailed via U.S. mail. Also, if
the log-on I.D. and password is to be mailed to a third party, indicate here.
Line 7. Persons to be granted registration. Provide the full name of the individual for whom the logon I.D. and password is requested. If you wish to transfer a log-on I.D. from an existing registration to
a new individual, indicate the name of the new registrant and the log-on I.D. to be assigned.
Line 8. Registration by Third Party. Indicate, by checking the applicable box, whether the person to
be granted registration in Line 7 is a third party (publisher, agent, etc.) of the registrant named in Line
1. The registration must be accompanied by an indication that the NVOCC has authorized the third
party to file NVOCC service arrangements and related documents on its behalf.
Line 9. Signature of Authorized Official. Indicate the date the registration was signed and title of
authorized official.
Paperwork Reduction Act Notice.
The collection of this information is authorized generally by section 16 of the Shipping Act of 1984, 46
U.S.C. app. § 1715.

This is an optional form. Submission is completely voluntary. Failure to submit this form will in no way
impact the Federal Maritime Commission's assessment of your firm's financial responsibility;
however, you will not be able to use the exemption set forth in the Commission's rules at 46 C.F.R.
part 531.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. The valid control number for this
information collection is 3072-0070 Copies of this form will be maintained until the filer indicates s/he
will no longer file NSAs into the electronic filing system.
The time needed to complete and file this form will vary depending on individual circumstances. The
total estimated average time to complete this form is: Recordkeeping, 20 minutes; Learning about the
form, 20 minutes; Preparing and sending the form to the FMC, 20 minutes.
If you have comments concerning the accuracy of these time estimates or suggestions for making
this form simpler, we would be happy to hear from you. You can write to the Secretary, Federal
Maritime Commission, 800 North Capitol Street, N.W., Washington, D.C. 20573-0001, or e-mail:
[email protected].

FORM FMC-78
OMB No. 3072-0070 (expiration date: 9/30/2008)

NVOCC SERVICE ARRANGEMENT REGISTRATION
PLEASE TYPE OR PRINT (SEE ATTACHED INSTRUCTIONS)

1. Organization No.
2. Registrant
Full Legal Name of firm (or individual, if not a firm)
(Doing Business As or Trade Name)

3. a. NVOCC OTI License No. _____________________ Effective date _________________________
MM/DD/YYYY
OR
b. If foreign-based unlicensed NVOCC, provide the following information for agent for service of process:
Name:

__________________________________

Address:

___________________________________
___________________________________
___________________________________

4. This Registration is: [ ] Initial [ ] Amendment (Specify change)
5. Headquarters
__________________________________________________________(____)____________
Address
(Number and Street)

Telephone
(
Fax

(Number and Street)

(City/State/Zip/Country)

6. Mailing
Address
(If different)

(Federal TIN Number, if any)

(
(c/o Name)

)

(Number and Street)

(Number and Street)

(City/State/Zip/Country)

E-Mail (optional)

)
Telephone

(
Fax

)

E-Mail (optional)

7. Person(s) to be granted registration. Please list individual(s) for whom a log-on identifier is requested. If this is
a transfer of log-on, please list the existing name and existing log-on ID:
Name: __________________________________ Existing Log-on: ______________________
8. Is the person listed in question 7 a third party? (check one) [ ] Yes [ ] No If yes, a letter of authority must be
submitted with this form.
9.
Signature of Authorized Official
_________________________________
date (MM/DD/YYYY)

Print or type name of Authorized Official
____________________________________
Title of Authorized Official

FMC USE ONLY
Logon__________________ ID___________________Directory__________________DateAsg_____/_____AsgBy___________________________
9/2005