License Application Form - Schedule 1

OMB Control Number: 0648-0218
Expires: 03/31/2023
Information Collection Under the South Pacific Tuna Act
This collection of information is required under regulations at 50 CFR 300, Subpart D. These regulations are issued
under authority of the South Pacific Tuna Act of 1988 (SPTA), which implements the Treaty on Fisheries Between
the Governments of Certain Pacific Island States and the Government of the United States of America (Treaty).
Under these regulations, operators of U.S. purse seine vessels seeking licenses under the Treaty are required to
submit completed license application forms (and optionally, expressions of interest in such licenses) and FFA Vessel
Register applications/VMS registration forms (50 CFR 300.32). Operators of U.S. purse seine vessels licensed under
the Treaty are required to submit completed catch report forms and unloading logsheets (50 CFR 300.34).
Public reporting burden for this collection of information is estimated to average: (a) for the optional expressions of
interest in vessel licenses, 15 minutes per response for license renewals and 120 minutes per response for initial
licenses; (b) for the license application forms, 60 minutes per response; (c) for the FFA Regional Register
applications/VMS registration forms, 45 minutes per response; (d) for the catch report forms, 60 minutes per
response; and (e) for the unloading logsheet, 30 minutes per response. These estimates include time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other suggestions for
reducing this burden to: Regional Administrator, NMFS, Pacific Islands Regional Office, 1845 Wasp Blvd., Bldg
176, Honolulu, Hawaii 96818
This information is collected by NMFS and transmitted to the Pacific Islands Forum Fisheries Agency (FFA)
pursuant to the Treaty and the SPTA. Confidentiality of the information collected in the catch report forms and the
unloading logsheets is maintained by NMFS pursuant to section 973j of the SPTA, and is treated in accordance with
NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. However, NOAA and NMFS
have no direct control over the confidentiality policies and practices of the FFA, so once the information is
transmitted to the FFA, NMFS and NOAA cannot provide any assurance of confidentiality.
Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be
subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the
Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.
This collection of information has been approved by the Office of Management and Budget (OMB) under control
number 0648-0218.
Privacy Act Statement
Authority: The collection of this information is authorized under the Western and Central Pacific Fisheries
Convention Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq) and the South Pacific Tuna Act of 1988 (16
U.S.C. 973g and 973j).
Purpose: In order to fulfill obligations under the South Pacific Tuna Act of 1988, the NOAA National Marine
Fisheries Service (NMFS) requires the submission of an unloading logsheet by U.S. purse seine vessel owners and
operators operating in the Western and Central Pacific Ocean.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery
participants. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be
shared within NMFS offices, in order to coordinate monitoring and management of sustainability of fisheries and
protected resources, as well as with the applicable State or Regional Marine Fisheries Commissions and International
Organizations. Disclosure of this information is also subject to all of the published routine uses as identified in the
Privacy Act System of Records Notice, NOAA-6, Fishermen’s Statistical Data.
Disclosure: Furnishing this information is mandatory under 50 CFR 300.34.

OMB Control Number: 0648-0218
Expires: 03/31/2023

SCHEDULE 1
TREATY ON FISHERIES BETWEEN THE
GOVERNMENTS OF CERTAIN PACIFIC ISLAND
STATES AND THE GOVERNMENT OF THE
UNITED STATES OF AMERICA
LICENSE APPLICATION FORM
Application is hereby made for a license authorizing the use of the vessel named in this application for fishing in
the Licensing Area.
1.

FULL NAME OF VESSEL:________________________________________________________________

2.

RADIO CALL SIGN OF VESSEL:__________________________________________________________

3.

REGIONAL REGISTER NUMBER OF VESSEL:______________________________________________
(If none, fill in and attach the FFA Regional Register form)

4.

FULL NAME AND ADDRESS OF EACH PERSON WHO IS AN OPERATOR OF THE VESSEL AND
STATE WHETHER OWNER, CHARTERER, MASTER OR OTHER. IF OTHER, SPECIFY DETAILS:
______________________________________________________________________________________
______________________________________________________________________________________

5.

FULL NAME AND ADDRESS OF INSURER FOR PURPOSES OF ARTICLE 4.3(a) OF THE TREATY:
______________________________________________________________________________________
______________________________________________________________________________________

6.

REGISTRATION NUMBER AND MAKE OF HELICOPTER, IF ANY, TO BE CARRIED ON VESSEL:
______________________________________________________________________________________

7.

REGISTRATION NUMBER, MAKE AND NAME AND ADDRESS OF OPERATOR OF ANY AIRCRAFT
TO BE USED IN ASSOCIATION WITH FISHING ACTIVITIES:
______________________________________________________________________________________
______________________________________________________________________________________

8.

STATE WHETHER OWNER OR CHARTERER IS INSOLVENT OR IN ANY BANKRUPTCY
PROCEEDING UNDER THE BANKRUPTCY LAW OF THE UNITED STATES:
______________________________________________________________________________________

9.

STATE WHETHER OPERATOR OF VESSEL HAS BEEN INVOLVED IN A VIOLATION OF THE
TREATY. IF YES, SPECIFY DETAILS:
______________________________________________________________________________________
______________________________________________________________________________________
For NOAA Office Use Only:

________________________
Date of Application

______________________________________
Administrator of the Pacific Islands Region
NOAA - National Marine Fisheries Service

FFA 1-May-18 (Page 1 of 2)

Forum Fisheries Agency Vessel Register

VID number – FFA use only

Application for Registration
(use block letters)
1. Vessel
Name of Fishing vessel in English

Flag State

International call sign

MMSI (if issued)

Flag State Number

Port of registry

6. Vessel Charterer/Commercial Operator
Name
Mailing address

Date Entered into Flag State Register
Fax number

Phone number
UVI/IMO No.
2. Vessel's previous details

Status

E-mail address

Parallel Registry (if applicable)
7. Vessel Fishing Master

Date Ship De-registered
(by the previous flag state, if applicable)

Name

Has a previous FFA Vessel Register application been made for
this vessel ?
if a vessel_id number was
issued, provide this number
No
Yes

Phone number

Vessel's previous name
Last radio call sign

Mailing address

Last flag state registration number

Last country of registration

Year change occurred

Fax number

E-mail address

8. Vessel Type
Single Purse Seine

3. Vessel contact details
Phone number

No. FADs on board

Fax number

E-mail address

No. Auxiliary boats

Helicopter model

Group Purse Seine
Mothership

4. Vessel Registered Owner

Net boat

Nationality

Name

Search boat

Longline
Length specified as:

Max number hooks Mainline length

Mailing address

km

nm

Mainline material

Phone number

Fax number

E-mail address

Website

Polyster (black tarred or vinyl red tarred) -includes
Kuralon, Dacron and Polytex
Nylon or Polyamide Nylon (monofilament or braided)
Other - specify

5. Vessel Master/Captain
Pole and line

Name

Fish Carrier / Reefer

Other - specify
Bunker
9. Vessel Specifications
Gross tonnage
Year built (year of initial launch)

Mailing address

Phone number

Troller

Fax number

Ship Builder
Country built
Hull Number

E-mail address

Hull material
Steel

Fibreglass
Wood

Other – specify

Aluminium

FFA 1-May-18 (Page 2 of 2)

Net Tonnage

Depth
Type

Moulded Depth

Beam/
Breadth
Vessel length (complete all lengths)

Beam/
Breadth Type

Dead Weight
LOA

13. Applicant declaration

I hereby apply for 'Good Standing' of the (name of vessel)

Lengths specified as:
metres
feet

RL

Length Between Perpendiculars:

I declare that, to the best of my knowledge, there are no
outstanding matters pending in relation to this vessel or its use.
● I declare that the information provided in this application for
registration, signed by me is true, accurate and complete.

●

Rated speed (knots) Normal crew compliment

Engine model

Amount specified as:
gallons
kilolitres

Total fuel carrying capacity

KW

HP
Refrigerant Used: Type

●

Amount specified as:

Total power of main Engine or Engines

PS

Capacity (Kg)
Amount specified as:

Total storage capacity

on the FFA Vessel Register.

cubic metres

metric tonnes
Major storage methods

●

I understand that I am required to report any changes to the
information provided within 60 days, and further understand
that failure to do so may adversely affect the good standing of
this vessel on the FFA Vessel Register.
As the owner/charterer/duly authorised agent of the
ALC/MTU identified above and installed on this vessel, I
hereby authorise Pacific Islands Forum Fisheries Agency to
electronically monitor the unit and disseminate data received
from it, in accordance with the FFA policy.

Signature
Date _____________

Ice

Refrigerated sea water

( dd mm yy )

Brine (NaCl)

Air (coils)

14. Attachments
10. Vessel's Mobile Transceiver Unit (MTU) Details
Visit the FFA web site (www.ffa.int) or contact FFA for listing
of VMS Type-Approved MTUs and Installers.
Provide the MTU information details below.

●
●

●
●

Inmarsat Mobile Number (IMN)

●

Inmarsat Serial Number (ISN)

●

MTU Serial Number

Attach the following documentation to your application:
a copy of the vessel's flag state registration certificate;
a copy of valid flag state authorisation to fish outside of its
EEZ and within the WCPFC Convention Area;
company ownership details and proof of corporate registration;
a recent (12 months or less) date stamped, 15cm x 20cm
(6”x8”) color side-view & plan-view photos of the vessel;
copy of the vessel's schematic stowage plan; and
copy of the MTU inspection certificate.

15. Authorised MTU installer / Service agent details (15. &
16. required for new or replacement MTU installations)

MTU Manufacturer
MTU Model Identification

Name

MTU Software Version

Company Name

11. Applicant details
Company contact details

Name
Mailing address

16. MTU installer declaration
Fax number

Phone number

E-mail address
Tick the box that applies to you
Charterer

Owner

Authorised agent

I, ______________________________________________,
the installer of the Mobile Transceiver Unit identified above
declare that I have installed the specified unit in accordance
with the MTU/ALC vendor's installation guidelines and the
unit has been inspected in accordance with FFA's 'MTU/ALC
Inspections Guidelines' as published from time to time.

12. Application period
Month

from

Year

Month

to

/

Year

/

Signature _________________________ Date ____________
( dd mm yy )
(MTU installer / Service agent)

18. UVI/IMO Required Information

17. Automatic Identification System Details

Official Number

AIS Make

Engines
Fishing
Number

Number of Engines
Previous Fishing
Number

AIS Model
AIS Serial Number

What Class AIS
is installed