Pilot Licence (PL) Application Form
APPLICATION FOR A MARITIME LICENCE
MSF054
Maritime New Zealand, Seafarer Certification, PO Box 25620, Wellington 6146. Phone 0508 732 237
SECTION 1
To be completed by all candidates
Surname:
First Name(s):
Nationality:
Date of Birth:
Place of Birth:
Address:
Home Phone:
(Postal)
Fax Number:
:
Mobile Phone:
Code
E-mail
Address:
SECTION 2
Please tick what you are applying for
New licence
Higher grade licence
Renewal of licence
Grade of licence:
Level of higher grade:
Replacement of licence
_
_
SECTION 3
Please tick which pilotage area(s) you are seeking a licence
for
Auckland
Napier
Taranaki
Bay of Islands
Nelson
Tauranga
Bluff
Otago
Timaru
Fiordland
Pelorus Sound, Admiralty Bay and
Tory Channel
(specify area below after referring to
French Pass
website for details**)
Gisborne
Queen Charlotte Sound
Wellington
Lyttelton
Stewart Island
Westport
Manukau
Taharoa Terminal
Whangarei
Other ** - please specify:
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**For details of pilotage areas – please refer to Maritime Rule Part 90: Pilotage - Appendix 1: Pilotage areas and
limits:
For the requirements of applying for a Pilot Licence please refer to Maritime New Zealand Rule Part 90.41.
If you want to authorise a person or company to act as your agent in respect of this application you will need to
complete an ‘Authority to Act as an Agent’ form as well.
Version 4 – July 2017
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