Form FMC-65 Foreign-Based Unlicensed NVOCC Registration/Renewal

OMB No. 3072-0018
(Expires 12/31/2023)

Form FMC-65 Foreign-based Unlicensed NVOCC Registration/Renewal
REGISTRATION

RENEWAL

CHANGE

1. Legal Name of Registrant:
_______________________________________________________________________________
Name listed above must match legal name on official documentation exactly, including punctuation
2. Trade Name(s):
_________________________________________________________________
3. Principal Place of Business Address - number, street, and room or suite number:
_________________________________________________________________
City or town, and Country (include applicable postal codes)
_________________________________________________________________
4. Telephone Number (include country code):

Fax Number (include country code):

_______________________________________________________________________________
5. Name of Contact Person:

Email Address of Contact Person:

_______________________________________________________________________________
6. Legal Agent for Service of Process in the U.S.:
Name of Agent:
_______________________________________________________________________________

Address - number, street, and room or suite number:
______________________________________________________________________________
City or town, state, and zip code:
________________________________________________________________________________
Telephone Number:

Fax Number:

_________________________________________________________________________________
Name of Contact Person:

Email Address of Contact Person:

______________________________________________________________________________

OMB No. 3072-0018
(Expires 12/31/2023)

CERTIFICATION
I certify that I have read a copy of the Federal Maritime Commission’s ocean
transportation intermediary regulations, 46 CFR Part 515, and pertinent sections of the Shipping
Act of 1984, as amended by the Ocean Shipping Reform Act of 1998 and the Coast Guard
Authorization Act of 1998 (46 U.S.C. 40101 et seq.), governing ocean transportation intermediaries,
and that I will abide by all the provisions thereof from this date forward.
Under penalties of perjury, I declare that I have examined this registration and to the best of
my knowledge and belief, it is true, correct and complete.
Note: Certification must be executed by the sole proprietor if registrant is a sole proprietorship, by
all partners if registrant is a partnership, by a corporate officer if registrant is a corporation, or
by a member if registrant is a limited liability company.

__________________________________
Signature
___________________________________
Name
___________________________________
Title
___________________________________
Date

-2-

Form FMC-65
(Rev. 12/2020)