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Request Amver SURPIC for SAR Operation(s)
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Required fields are indicated in red (with *)
Contact Information
*
:
*
Name of Point of Contact
*
E-mail
*
Organization
*
Phone Number
Fax Number
Nature of Distress
*
:
Fire
Flood
Capsized
Man Overboard
Other
Date of Distress:
Date
Vessel Information:
Vessel Name
Vessel Call Sign
Num. of persons on board
Type
Gross tonnage/Length
IMO Number
MMSI ID Number
Communications
*
:
INMARSAT
Number
TELEX
Number
RADIO
Number
Other
Value
Location of Distress
*
:
*
Lat. (DDMM)
*
Heading
N
S
*
Long. (DDDMM)
*
Heading
E
W
SURPIC Radius from Location of Distress
*
:
*
Radius Desired
in nautical miles
Special Instructions:
Message
Please answer the security question.
*
:
What is 10 + 3 ?
Answer:
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Last Modified 1/10/2012