The BoatU.S. MMSI Program has been certified by both the Federal 
Communications Commission and the U.S. Coast Guard to assign MMSI 
numbers to vessels with DSC capable radios that are not required 
by law to carry a radio, and do not make international voyages or 
communications.  

Following is a printer friendly MMSI# Assignment Form. You may 
download this form and return it to BoatU.S. via mail or fax.


IMPORTANT NOTE:  
Depending on the manufacturer of your DSC radio, your MMSI# may
only be able to be entered twice during the initial set up process.
If you try to program your radio more than twice with the assigned 
MMSI#, the radio may have to be sent back to the manufacturer. 
Please be careful when initially entering your newly assigned MMSI 
number.


INSTRUCTIONS:
1. Complete the MMSI Assignment Form on the next page.  
2. Note the required fields as indicated by an(*).  These fields
   must be completed in order to receive an MMSI number.
3. Refer to the Ship Classification table when completing the 
   Ship Classification question.
4. Return the Assignment Form (next page) to:
   		
		BoatU.S. MMSI Program  
		880 S. Pickett St.
		Alexandria, VA 22304.
			    OR 
		Fax to: BoatU.S. MMSI Program
		        703-461-2840 
		MMSI Info Line: (800) 563-1536

*The MMSI ASSIGNMENT FORM may be found on the next page (scroll 
down to view on the web browser).
























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			MMSI ASSIGNMENT FORM

*Denotes a required field.  These fields must be completed in order
to receive an MMSI#.
----------------------------------------------------------------------------------------

*OWNER'S FIRST NAME:____________________________________________________________________

*OWNER'S LAST NAME:_____________________________________________________________________

      OR  COMPANY NAME:_________________________________________________________________

* STREET ADDRESS:_______________________________________________________________________

* CITY:__________________________________________________  * STATE:_____________________

* ZIP CODE:__________  PROVINCE, MAIL CODE, COUNTRY: ___________________________________

*OWNER'S HOME PHONE:________________

OWNER'S WORK PHONE:_________________	EMAIL ADDRESS:__________________________________
				(Confirmation will be sent to email address, if provided)


*NAME OF PRIMARY EMERGENCY CONTACT ASHORE:______________________________________________

*PRIMARY CONTACT HOME PHONE:____________________________________________________________

PRIMARY CONTACT WORK PHONE:_____________________________________________________________



NAME OF ALTERNATE CONTACT ASHORE:_______________________________________________________

ALTERNATE CONTACT HOME PHONE:___________________________________________________________

ALTERNATE CONTACT WORK PHONE:___________________________________________________________



VESSEL NAME:____________________________________  RADIO CALL SIGN:______________________

VESSEL WIRELESS PHONE 1:_______________________   WIRELESS 2:___________________________

VESSEL WIRELESS PHONE 3:_______________________   WIRELESS 4:___________________________

INMARSAT TELEPHONE #:_______________________


VESSEL FLAG STATE(Usually USA):_________________________________________________________

*SHIP CLASSIFICATION (SEE TABLE BELOW):_________________________________________________

EX-SHIP NAME (IF KNOWN):________________________________________________________________  

EX-CALL SIGN (IF KNOWN):_________________________ EPIRB ID CODE:________________________

*VESSEL REGISTRATION NUMBER:______________________________________________
		OR
*DOCUMENTATION NUMBER:______________________________________________

*VESSEL HOME PORT:(Marina Name or Residence)____________________________________________

PORT CITY:________________________________________  PORT STATE:_________________________

ALTERNATE VESSEL HOME PORT:_____________________________________________________________

*CAPACITY (# OF PERSONS EXPECTED TO BE ON BOARD):_______________________________________   

SHIP'S RADIO INSTALLATION (VHF, DSC, MF/HF WITH DSC, MF/HF W/O DSC,

 AIS TRANSPONDER, CELL PHONE, ETC.):____________________________________________________

REMARKS (BOAT LENGTH, COLOR, TYPE, ETC.):_______________________________________________

________________________________________________________________________________________ 

________________________________________________________________________________________



*The SHIP CLASSIFICATION TABLE may be found on the next page (scroll 
down to view on the web browser).











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		*SHIP CLASSIFICATION TABLE

DUN - KETCH                     MTB - MOTOR BOAT
SLO - SLOOP                     YAT - YACHT
GOL - SCHOONER                  VLR - SAILING SHIP
SAE - RESCUE VESSEL             XXX - UNSPECIFIED

*Note: If XXX-Unspecified, please be sure to describe the vessel in the remarks section