Special Coral Reef Ecosystem Fishing Permit Application Form - Noaa Fisheries Service
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2OMB Control No. 0648-0463
NOAA Fisheries Service
Expires: 2/28/2009
Pacific Islands Region
1601 Kapiolani Blvd. Suite 1110
Honolulu, HI 96814-4700
Ph: (808) 944-2200; FAX: (808) 973-2941
Special Coral Reef Ecosystem Fishing Permit Application Form
Applicant Information
Date:
/
/
Name:
Phone:
Fax:
Address:
Street
Apt.#
City
State
ZIP
Vessel Name:
Home Port:
Length (ft):
Net Tonnage:
Gross Tonnage:
Vessel:
USCG Documentation___; State License___; Vessel Registration___
(check one)
Number:
Vessel Operator:
Name:
Phone:
Fax:
Address:
Street
Apt.#
City
State
ZIP
Is this permit solely to transship coral reef ecosystem taxa received from another vessel around the EEZ of the Northwest Hawaiian Islands, the
Pacific Remote Island Areas, or any other MPA? ________
Do you agree to accommodate an observer on board while fishing, if required?_______
Does vessel have an individual Vessel Monitoring System?______
Does vessel have insurance covering removal/clean-up in event of a grounding?_____ Name of Insurer: __________________________
Do you agree to submit daily log data within 30 days of returning to port?_____ or transshipment log data within 7 days of returning to port? _____
Check any special exemption for which you qualify and would like to be eligible for under this permit application (attach description of
conditions under which you apply):
Other FMP ____
Scientific Bioprospecting ___
General Indigenous ____
Indigenous use of live rock/coral ____
Aquaculture seed stock of coral ____
In which EEZ Management Subarea will fishing be conducted? (check only one)
Main Hawaiian Islands ____
Northwestern Hawaiian Islands ____
American Samoa ____
Guam ____
Guam’s Southern Banks ____
CNMI ____
PRIA (specify) _________________________________________
Describe your intended fishing effort, general fishing grounds, gear to be used and methods of collection
Target Species or Taxa
Expected Incidental Species or Taxa
Species Name
Expected Catch
How will it be
Why
Species Name
Expected Catch
Keep?
1
2
(lb) (#, wt.)
processed?
harvested?
(lb) (#, wt.)
1
Live, fresh, frozen, preserved, other
2
Food, ornamental, research, other
Use back, if necessary; total expected catch during permit period for target species required for permit approval
Attach statement regarding objectives of fishing operation, estimated ecosystem, habitat and protected species impacts, and any
additional information to help support approval of this application
This information is true to the best of my knowledge.
Signature:
Please return completed and signed application to: NOAA Fisheries Service, Pacific Islands Region
1601 Kapiolani Blvd., Suite 1110, Honolulu, HI 96814-4700
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