Form 791 | AMSA

APPLICATION FOR WILDLIFE OR OTHER SIGHTSEEING EXEMPTION – AMSA 791

Marine Safety (Domestic Commercial Vessel) National Law Act 2012

EX13 - Marine Safety (Wildlife or other sightseeing) Exemption 2020

Guidance on when to use this form

If you are unsure of any information please leave blank.

If approved under EX 13, a person is exempt from the requirement to hold a certificate of competency that would be required for an operation using the vessel for viewing wildlife or other sightseeing in an area permitted by a State or Territory, in inland waters.

A. Applicant details

Name (individual)

ACN (if applicable)

ABN (if applicable)

Vessel name

Unique Identifier

Vessel length (must be <12m)

Vessel power (must be <100kW if inboard)

B. Provision of information

What is the operation and where is it?.
Will the operation be conducted at less than 10 knots on inland waters?

Yes No
Have you attached information in support of the applicant's ability to be the master of the vessel? (Example - photo identification and a short summary of relevant experience and training, including any lower maritime qualifications, first aid etc?)

Yes No

C. Applicant’s declaration and consent

I declare that:

To the best of my knowledge the information provided by me in this application (and any attachments I have included with this application) is true and correct.
I consent to the Australian Maritime Safety Authority, as the National Regulator, making all reasonable enquiries in order to verify that the information provided by me in this application (and any attachments I have included with this application) is true and correct.
I understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, may ask that I provide any information or document that the National Regulator reasonably considers necessary for consideration of this application.
I understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, may ask another person to provide any information, document or agreement that the National Regulator reasonably considers necessary for consideration of this application.

Signature

Name

Please use a BLACK pen and ensure your signature fits inside the signature box

Date

Privacy Statement

The collection of information requested in this form is required or authorised by Schedule 1 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (the Act). It will be used for purposes related to the Act and may be provided to Commonwealth or State/Territory government agencies for the purposes of marine safety. Failure to provide the information may result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how your information may be used or disclosed for purposes beyond those described in this statement, visit www.amsa.gov.au/privacy.

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