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By completing this form, the ship's Master confirms all data provided is true and correct at the time of issue. Failure to provide the correct information, or if it is issued late, could result in pilotage being delayed or cancelled, with all costs to the ship's account. The Master must inform Whangarei Harbour Radio immediately of any changes or updates to the ship's navigational status.

Version
FOR_12-109B VMI Rev 2