Application Form For Certificate Of Identity Page 2

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Details of 3rd Owner
Forename
Surname
Address
Nationality
Country of birth
Passport Number
Date of birth (day/month/year)
/
/
Male ☐ / Female ☐
Gender (delete as appropriate)
County
Daytime phone
Country
E-mail
Terms & Conditions for a Certificate of Identity
By applying for an ISA Certificate of Identity I declare that I have read and agree with and to abide by the following terms and conditions;
1.
The information provided by me in this application is true and correct.
2.
I will keep the contact details up to date.
3.
The Identity number I have applied for is for the craft in the original application and may not be transferred to any other craft.
4.
In the event of me ceasing to be the owner of this craft I will inform the ISA and the Certificate of Identity in my name will be terminated.
The new owner may apply under the crafts existing identity number.
5.
I agree that the information provided in my application may be provided by the ISA to third parties for the purposes of identifying my craft
and associated registered owners.
Signature:
I confirm that;
I wish to apply for the ISA Certificate of Identity on behalf of the people listed as owners on this form; and
I am over 18 years of age
Signature: .........................................................................................................
Date: ...............................................
ISA Members
Normal (max 3 weeks)
Expedited (5 working days)
Validity Period
€50.00
€75.00
Certificate of Identity
5 years
€50.00
€75.00
Renewal / Update
5 years
Racing Handicaps
No Additional Fee
1 year maximum
Racing Sail Number
No Additional Fee
Change of Ownership
Online Shop
>>Shop>> Publications>>
Shop Order Number: ……………………..
Certificate of Identity
Payment
Enclose payment to “Irish Sailing Association”
options
Cheque / Postal Order
Credit card
Use details below
Card Number
Card Type
Security Code (last 3 digits from number on the back of credit card)
Expiry date
Card holders name if different from above
I Authorise the ISA to debit amount of:€
Card Holders Signature
Revised 23/03/2016

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