Online Form - Extended Mooring Time Application

Application must be made at least three full business days prior to planned travel or when practicable.

Applicant Details

Full Name*

Business Name

Postal Address

Postal Address:*

City:*

State:*

Post Code:*

Country:*

Street Address

Street Address:

City:

State:

Post Code:

Country:

Contact Number - HOME

Contact Number - MOBILE*

Contact Number - BUSINESS

Email*

Vessel Details

Vessel Type (power, under sail etc)*

Registration Number*

Call Sign

Length and Displacement

Time Extension Details

From

On*

Reason for Extension Request*

Please note that this consent will be granted with the following conditions:
(a) An Application to Moor a Vessel Permit is valid only when carried on the vessel;
(b) Permit applies for the purpose issued and vessel listed only;
(c) No responsibility will be accepted by the Shire for any, disabled or damaged vessels arising from use of the permit;
(d) Damage caused to the structure if used during unsuitable conditions may be debited to the vessel owner, depending on the circumstances;

Please type your name below to signify that you agree that all information given above is true and correct at the time of submission*

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