Obrazac_Zahtjev Za Vez
1
ACI marina Pomer, Pomer 26/A, HR-52100 Pula, Tel: +385 52 573 162 ZAHTJEV ZA VEZ • REQUEST FOR A BERTH ANFRAGE LIEGEPLATZ • RICHIESTA D'ORMEGGIO IME PLOVILA (S/Y, M/Y, KAT) : ________________________________________________________________________ NAME OF VESSEL • BOOTSNAME • NOME DELL' IMBARCAZIONE PROIZVOĐAČ I MODEL : __________________________________________________________________________________ MAKE & MODEL OF VESSEL • HERSTELLER & FAHRZEUGTYP • DITTA COSTRUTTRICE E MODELLO DUŽINA PREKO SVEGA (m) : _____________________________________________________________________________ LENGHT OVERALL • LÄNGE ÜBER ALLES • LUNGHEZZA FUORI TUTTO GAZ MAKSIMALNI (m) : ___________________________________________________________________________________ DRAFT • TIEFGANG • PESCAGGIO GODINA GRADNJE : _______________________________________________________________________________________ YEAR BUILT • BAUJAHR • ANNO DI COSTRUZIONE ZASTAVA : __________________________________________________________________________________________________ FLAG • FLAGGE • BANDIERA MATERIJAL GRADNJE : ___________________________________________________________________________________ CONSTRUCTION MATERIAL • RUMPFBAUSTOFF • MATERIALE DI COSTRUZIONE VLASNIK PLOVILA : _______________________________________________________________________________________ OWNER OF THE VESSEL • EIGENTÜMER • PROPRIETARIO ADRESA : ___________________________________________________________________________________________________ FULL ADDRESS • ANSCHRIFT • INDIRIZZO TELEFON / FAX / E-MAIL : _________________________________________________________________________________ PHONE N° FAX N° ZAHTJEV ZA / REQUEST FOR / ANFRAGE FÜR / RICHIESTA PER : a) GODIŠNJI VEZ / ANNUAL BERTH / JÄRLICHER LIEGEPLATZ / ORMEGGIO ANNUALE b) MJESEČNI VEZ / MONTHLY BERTH / MONATLICHER LIEGEPLATZ / ORMEGGIO MENSILE ZAHTJEV ZA PERIOD OD __________________ DO ___________________ REQUESTED PERIOD FROM - TO • ANFRAGE FÜR ZEITRAUM VOM - BIS • RICHIESTA PER IL PERIODO DAL - AL ____________________ ______________________ (Datum / Date / Datum / Data) (Potpis / Signature / Unterschrift / Firma)
description
morje
Transcript of Obrazac_Zahtjev Za Vez
-
ACI marina Pomer, Pomer 26/A, HR-52100 Pula, Tel: +385 52 573 162
ZAHTJEV ZA VEZ REQUEST FOR A BERTH ANFRAGE LIEGEPLATZ RICHIESTA D'ORMEGGIO
IME PLOVILA (S/Y, M/Y, KAT) : ________________________________________________________________________ NAME OF VESSEL BOOTSNAME NOME DELL' IMBARCAZIONE PROIZVOA I MODEL : __________________________________________________________________________________ MAKE & MODEL OF VESSEL HERSTELLER & FAHRZEUGTYP DITTA COSTRUTTRICE E MODELLO DUINA PREKO SVEGA (m) : _____________________________________________________________________________ LENGHT OVERALL LNGE BER ALLES LUNGHEZZA FUORI TUTTO GAZ MAKSIMALNI (m) : ___________________________________________________________________________________ DRAFT TIEFGANG PESCAGGIO GODINA GRADNJE : _______________________________________________________________________________________ YEAR BUILT BAUJAHR ANNO DI COSTRUZIONE ZASTAVA : __________________________________________________________________________________________________ FLAG FLAGGE BANDIERA MATERIJAL GRADNJE : ___________________________________________________________________________________ CONSTRUCTION MATERIAL RUMPFBAUSTOFF MATERIALE DI COSTRUZIONE
VLASNIK PLOVILA : _______________________________________________________________________________________ OWNER OF THE VESSEL EIGENTMER PROPRIETARIO ADRESA : ___________________________________________________________________________________________________ FULL ADDRESS ANSCHRIFT INDIRIZZO TELEFON / FAX / E-MAIL : _________________________________________________________________________________ PHONE N FAX N
ZAHTJEV ZA / REQUEST FOR / ANFRAGE FR / RICHIESTA PER :
a) GODINJI VEZ / ANNUAL BERTH / JRLICHER LIEGEPLATZ / ORMEGGIO ANNUALE b) MJESENI VEZ / MONTHLY BERTH / MONATLICHER LIEGEPLATZ / ORMEGGIO MENSILE
ZAHTJEV ZA PERIOD OD __________________ DO ___________________ REQUESTED PERIOD FROM - TO ANFRAGE FR ZEITRAUM VOM - BIS RICHIESTA PER IL PERIODO DAL - AL
____________________ ______________________ (Datum / Date / Datum / Data) (Potpis / Signature / Unterschrift / Firma)
