FCC 605 Schedule G FEDERAL COMMUNICATIONS COMMISSION Information and Instructions Instructions for Schedule for Exemption From Ship Station Requirements (Part 80) Approved by OMB 3060 - 0850 See 605 Main Form Instructions for public burden estimate Form FCC 605, Schedule G, is a supplementary schedule for use with the FCC Quick-Form Application for Authorization in the Ship, Aircraft, Amateur, Restricted and Commercial Operator, and the General Mobile Radio Services, FCC 605 Main Form. This schedule is used to supply information for Exemption from Ship Station Requirements in the Ship Radio Service (Part 80.59c). The FCC 605 Main Form must be filed in conjunction with this schedule. Application for exemption from the radio provisions of part II or III of Title III of the Communications Act, the Safety Convention, or the Great Lakes Radio Agreement, must be filed as a waiver request using FCC 605 Schedule G. Failure to fully answer questions contained in this application may delay the processing of your application. NOTE: THE PURPOSE ON THE FCC 605 MAIN FORM ITEM 2 MUST BE FILED AS NEW. Schedule G Instructions Item 1 Enter the name of the port of which the vessel is registered. Item 2 Provide the file number of exemption letter on previously granted exemption. Otherwise, leave blank. Item 3 Select the appropriate blocks(s) that indicates type of applicant/licensee. Item 4a Select the appropriate block describing the type of vessel. Item 4b Provide the number of crew, number of passengers and number of others the vessel will carry. Attach a copy of USCG Certificate of Inspection. Item 5 Select the appropriate block(s) for exemption requirement. Item 6 Select `Y' if the vessel will travel to a foreign port. Otherwise, enter `N'. Item 7 Select reasons for exemption request. You may select more than one reason. Item 8 Provide the quantity of each type of radio equipment being carried on board. For Single Side-Band, choose type. Item 9 Describe the voyage(s) for which applicant/licensee is requesting exemption. The description must include the maximum distance from the nearest land in nautical miles; the maximum distance between two consecutive ports in nautical miles; and the names of all ports of call and an indication of whether travel will include a foreign port. FCC 605 Schedule G ­ Instructions April 2014 ­ Page 1 American LegalNet, Inc. www.FormsWorkFlow.com FCC 605 Schedule G 1) Port of Registry: Schedule for Exemption from Ship Station Requirements in the Ship Radio Service (Part 80) Approved by OMB 3060 - 0850 See 605 Main Form Instructions for public burden estimate 2) If vessel has been granted an exemption previously, list the file number that appears on the upper right hand corner of the exemption letter. File Number of any previously granted exemption: _____________________ 3) Applicant/Licensee is: Owner Operator Charter Agent of above ship 4a) Vessel is certified by the U.S. Coast Guard as a: Passenger Cargo vessel 4b) The vessel will carry: Number of Crew ________, Number of Passengers ________, and Number of Others _______. Attach a copy of the U. S. Coast Guard (USCG) Certificate of Inspection 5) Requirement from which you request exemption: Radiotelephone (VHF/MF) GMDSS Radio Direction Finding Apparatus Yes No 6) Will vessel travel to a foreign port while navigating the voyages for which exemption is required? 7) Reason(s) for exemption request for the voyages described herein: Size of Vessel Variety of Equipment on Board Limited Routes Conditions of Voyages Other (Explain):______________________________________________________________________________ 8) Provide the quantity of radio equipment being carried on board the vessel: _____ VHF Radio Installation ( ) DSC ) MF ( ) HF ( ) DSC _____ NAVTEX Receiver (GMDSS approved) _____ 9 GHz Radar Transponder (GMDSS approved) _____ 500 KHz Distress Frequency Watch Receiver _____ Reserve Power Supply (Capability) _____ Single Side-Band (SSB ­ Band of Operations) Chose Type: ( _____ Category 1,406 EPIRB (GMDSS approved) _____ Survival Craft VHF (GMDSS approved) _____ Ship Earth Station _____ 2182 Radiotelephone Auto Alarm _____ Other Equipment (Specify)________________________________ 9) Describe in detail the voyages(s) for which the applicant/licensee requests an exemption, including, in nautical miles, both the maximum distance from the nearest land and the maximum distance between two consecutive ports as well as the names of all ports of call. (Note: Applicant/Licensee may also submit a nautical chart with application.) FCC 605 - Schedule G April 2014 ­ Page 1 American LegalNet, Inc. www.FormsWorkFlow.com