~ NORTHERN ~ TERRITORY ~.~'fl GOVERNMENT

DEPARTMENT OF INFRASRUCTURE, PLANNING AND LOGISTICS

Pilotage Exemption Certificate Application

Surname: Given Name(s):

Address:

Mobile: E mail:

Agent:

Agent contact: Phone: Email:

Please provide the following documents:

Medical Certificate:

Trip Record:

Certificate of Competency:

New PEC: Previous/Existing PEC number (if Applicable):

PEC Revalidation: Harbour Zones: Please circle applicable Zones

Vessel upgrade:

Zone upgrade:

Vessel and Zone upgrade:

1 LOA metres Vessel Names & LOA 2 LOA metres Up to four vessels can be

3 LOA metres nominated

4 LOA metres

Towage Requirements MAX LOA metres

Please confirm the type of payment:

Cheque: On Account:_______________________________________________

EFT:

Credit Card Name on Card:___________________________________________________

Card Number:_____________________________________ Expiry Date:____________________

Issue Date 18/10/2016 www.nt.gov.au Page 1 of 3

~ NORTHERN ~ TERRITORY ~.~'fl GOVERNMENT

DEPARTMENT OF INFRASRUCTURE, PLANNING AND LOGISTICS

Pilotage Exemption Zones Effective from July 2014

Zone A – Outer Pilotage Zone; Bounded by a line joining Charles Point and Lee point through a position 12˚18.2’S 130˚41.1’E, in the north, and a line joining Talc Head and Emery Point in the south.

Zone B – Port Junction Zone; Bounded by a line joining Talc Head and Emery Point, in the north, and a line joining Talc Head and eastern end of Stokes Hill Wharf, passing through Wickham Point, in the south.

Zone C – East Arm Zone; Bounded by a line joining Wickham Point and the eastern end of Stokes Hill Wharf, in the north and a NE/SW line passing through South Shell Island, in the south.

Zone D – Middle Arm Zone; That area of the port upriver of a line joining Talc Head and Wickham Point.

Zone E – Sadgroves Creek Zone; That area of the port north of a line from the eastern end of Stokes Hill Wharf to the entrance to Reichardt Creek.

Zone F – Hudson Creek Zone; That area of the port upriver of a line 200˚T from position 12˚29.6’S 130˚53.35’E at East Arm Wharf.

Zone G – Marine Supply Base; Connects Zone C to the Marine Supply Base (MSB) berths and is specific for

exempt seaman for these berths. The Zone is bounded by the navigation beacons B03 following the line of the

channel until immediately south, south west of B02 and then encompassing the Marine Supply Base beacons.

Issue Date 18/10/2016 www.nt.gov.au Page 2 of 3

~ NORTHERN ~ TERRITORY

~., GOVERNMENT DEPARTMENT OF INFRASRUCTURE, PLANNING AND LOGISTICS

Name: ___________________________

Existing PEC No: ___________________ (if applicable)

CANDIDATE FOR PILOTAGE EXEMPTION CERTIFICATE – RECORD OF TRIPS Trip No.

Date Time run

commenced From/Position

/Berth Zones

Transited Time run

completed To/Position/

Berth Day/ Night

Vessel Name LOA Pilot/Master Supervising

Pilot/Master Signature

1

2

3

4

5

6

7

8

9

10

Issue Date 18/10/2016 www.nt.gov.au Page 3 of 3