Berthing Registration Form — Telaga Harbour

Telaga Harbour Marina, Langkawi

Telaga Harbour Marina, Langkawi

Langkawi Gateway Marina

Berthing RegistratioN

Vessel Name *

Vessel Type *

Flag *

Official Registration Number *

LOA (m) *

Draft (m) *

Beam (m) *

GRT (ton)

Arrival Date *

MM

DD

YYYY

Departure Date

MM

DD

YYYY

Last Port *

Next Port

If applicable.

Insurance Carrier *

Validity of Insurance *

Start date to end date.

Category

Live-Onboard

Charter

Transient

Unattended

Electricity

16 amp / 3 pin

32 amp / 3 pin

63 amp / 3 pin

125 amp / 5 pin (PIER M)

200 amp / 5 pin (PIER M)

Name *

Captain or Owner

First Name

Last Name

Nationality *

Passport Number *

Email *

Phone *

Country

(###)

###

####

Address *

Caretaker

If applicable.

Caretaker Contact Details

DECLARATION

Do you keep firearms on board your vessel? *

YES

NO

If YES, please specify quantity and type.

Note: Firearm possession in Malaysia is strictly regulated under the Arms Act 1960 and the Increased Penalties Act 1971.

Do you keep pets on board your vessel? *

YES

NO

If YES, please specify the type of animal(s).

Note: All pets must be vaccinated. Under MAQIS Act 728, pets arriving from foreign ports must undergo a minimum 7-day on-premises quarantine.

TERMS & CONDITIONS OF BERTHING *

View the full Terms & Conditions here.

I, the owner/captain/manager of the above-mentioned vessel, confirm that the information provided is accurate and complete.

I have read, understood, and agree to the terms and conditions.

Signature *

In Block Letters

Thank you!

Telaga Harbour Sdn Bhd

Lot 1 Telaga Harbour Marina
Pantai Kok, Langkawi
07000 Kedah
Malaysia

Tel: +604 959 2202
Fax: +604 959 2204
Email: info@telagaharbour.com

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