ABN 61 760 960 480

By signing this form, I declare that all information and/or documents provided by me is true and correct and I understand the Privacy statement. I acknowledge that a copy of this form may be provided by VicRoads to the authorised representative of the Estate upon request. I have checked the vessel details provided by the disposer match the vessel.Signature

M M Y Y Y YDDM M Y Y Y YDD

Application for transfer of vessel registration from

deceased estate

This form must be completed and signed by both the authorised representative and acquirer and returned to VicRoads within 14 days. Please print clearly in ink using BLOCK letters. Do not use this form if the registration is expired or has been cancelled. Transport Safety Victoria on behalf of the Director, Transport Safety is responsible for the administration of the Marine Safety Act 2010 (Vic). VicRoads is an agent for Transport Safety Victoria and is responsible for the registration of vessels and the collection of fees. Thevessel register records the identification details of each vessel and the name and address of the person responsible for it. It is not a register of vessel ownership (title).Please return the completed form and fees to a VicRoads Customer Service Centre.

Registration number

Serial number

Date of transfer

I, as the authorised representative of the estate, request that the registration specified on this form

be transferred from the name of the deceased to the acquirer who is:

Me as the authorised representative The spouse or domestic partner of the deceased A person with a Beneficial Entitlement Another person

Copies: Original Submit to VicRoads Pink Authorised representative keeps Yellow Acquirer keeps

M M Y Y Y YDD

Y Y Y Y

Deceased persons (disposer) detailsSurname

Licence/Client number

Date of birth M M Y Y Y YDD

Given name(s)

Last known home address

M M Y Y Y YDD

Postcode

Last known postal address (if different from above)

Postcode

Acquirer detailsSurname or company name

Licence/Client number

Date of birth

Given name(s) or ACN

Home or company address

Postcode

Postal address (if different from above)

Postcode

VRPI

N02

888

10.1

2

998

53

Aut

horis

ed a

nd p

ublis

hed

by V

icR

oads

, 60

Den

mar

k St

reet

, Kew

, Vic

toria

, 310

1.

Contact phone number (optional)

Email address (optional) Note: If the vessel is registered in the name of an individual, that person must be at least fourteen years of age.

Vessel description Year manufactured Y Y Y Y Make of vessel Model

HIN (Hull Identification Number)

Type of vessel (please cross one circle in group)

CABCRU Cabin Cruiser HOUSEB House BoatHALCAB Half Cabin AIRCUS Air Cushion VehicleOPECAB Open Cabin PWC Personal Water CraftTRASAI Trailer Sailer CanoeYACHT Yacht

Does the vessel have an Australian Build Plate (ABP)? Yes No If any, please provide manufacturing date

Type of construction

M MetalW WoodF FibreglassC CompositeO Other

Type of engine (inboard/outboard)

Overall length (m)

Breadth (m)

Number of engines

Colour

No. of hulls 1 2 3 4

Engine number(s) Engine make(s) Horsepower Type of fuel

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

P PetrolD DieselE ElectricS SteamG Gas*M MultipleO Other *(eg: LPG)

Transfer fees payable Proposed registered operator (Acquirer) The fee payable by the proposed registered operator (Acquirer) when transferring operation of a registered vessel is $16.40. Fees are subject to change, please check VicRoads website.

Total payable $

Transport Safety Victoria (TSV) and VicRoads collect and hold the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Marine Safety Act 2010 (Vic) and Marine Safety Regulations 2012 (Vic). VicRoads and TSV are committed to protecting personal information in accordance with their obligations under the Marine Safety Act 2010 (Vic). The personal information provided in this application may be disclosed to other government agencies in accordance with section 306 of the Marine Safety Act 2010 (Vic) and section 177 of the Transport Integration Act 2010 (Vic). The individuals whose personal information is collected on this application have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this application should be informed of this fact. For more information on privacy please refer to the VicRoads brochure Protecting your Privacy, TSVs privacy statement at transportsafety.vic.gov.au/privacy, or contact VicRoads on 13 11 71. It is an offence under the Marine Safety Act 2010 (Vic) to give information that is false or misleading in relation to an application for registration of a vessel. Failure to provide the information may result in your application not being processed or records not being properly maintained. By signing this form, I declare that all information and/or documents provided by me is true and correct.

By signing this form, I declare that all information and/or documents provided by me is true and correct and I understand the Privacy statement. I acknowledge that a copy of this form may be provided by VicRoads to the acquirer upon request. I declare that this vessel is registered at the date of transfer and acknowledge that any remaining period of registration of this vessel is transferred to the acquirer.Signature

Signature of authorised representative/authorised agent

Date

Signature of acquirer/agent

Date

Post: VicRoads, GPO Box 1644, Melbourne, Victoria, 3001 Call: 13 11 71 (TTY 13 36 77, Speak and Listen 1300 555 727) Web: vicroads.vic.gov.au

THIS ORIGINAL MUST BE SUBMITTED TO VICROADS

VicRoadsInstructions for authorised representative/authorised agentPlease complete the form, print it then sign it. Thank you

VicRoadsInstructions for acquirer/agentPlease complete the form, print it then sign it. Thank you

VicRoadsImportant instructionsPlease note original must be submitted to VicRoads, one copy should be kept by the authorised representative/authorised agent, and one copy should be kept by the acquirer/agent.