Australian Government - Australian Maritime Safety Authority

AMSA forms

Bunkers convention certificate of insurance

Use this page to pay for and complete a AMSA Form 350 - Bunkers Convention - Certificate of Insurance application.

1 Applicant details


Title
First name
Last name
Email We will send a receipt to this email
Phone

2 Ship / Vessel details

Ship name
IMO If known, please provide the official number or IMO number of the ship. We are not able to search for ships by a unique vessel identifier (UVI) or state registration number.

3 What you are paying for

Please select from the following
Apply for a first issue if the following details have changed: vessel name, owner, insurance provider, or flag state.
$

or

Where no substantial changes have been made
$

AND

$

or

$
 
Total to pay (AUD)
$

How to submit

Please complete and submit the above payment form. Once completed, you will receive a payment reference number - place this into section 4 of the AMSA Form 350 - Bunkers Convention - Certificate of Insurance before submitting to OpsAdmin@amsa.gov.au". Application forms submitted without a payment reference will not be processed.


The Australian Maritime Safety Authority (AMSA) is collecting the personal information on this form to process your application for a certificate of insurance in accordance with the Protection of the Sea (Civil Liability for Bunker Oil Pollution Damage) Act 2008. It will be used for purposes related to that application and treated in accordance with the Australian Privacy Principles. Failure to provide the information may result in the application 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, visit AMSA’s privacy policy at  www.amsa.gov.au/privacy
AMSA form: 350
Version: 1 11/24