DUTCH FLAG / Request for a certificate of deletion

DUTCH FLAG / Request for a certificate of deletion
Please send your documents to
VGD - Département immatriculations - Les Bertons – Chemin du Pré Martin - 17350 Saint-Savinien - France
Phone +33 (0) 535 540 086 - fax +33 (0) 5 46 90 86 33 email : [email protected]
1. Copy of ID card or passport for the owner of the boat
2. Application form here bellow, signed by each owner
3. Original flag certificate that we will return to the concerned authorities
4. Proof of payment of the fees
Details to proceed to a bank transfer
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IBAN: FR76 3004 7142 8400 0200 1880 106 - BIC: CMCIFRPP
In case the flag certificate is not in your name, send us also an ORIGINAL bill of sale
MANDATE
PROCURATION
I undersigned,
Je soussigné,
First Name (Prénom) :
Last Name (Nom) :
Address
Adresse
Give mandate to
donne procuration à
The company VGD, «les Bertons», 17350 Saint Savinien, France
Represented by Mrs Elisabeth CADOR,
In order to get the certificate of deletion (withdrawal certificate) of my boat
afin de demander la radiation de mon bateau
Name of the boat (nom du bateau):
Registration Number (n° d’immatriculation):
My percentage of shares of the boat is
Mon pourcentage de parts de bateau est
To
auprès de :
%
The concerned authorities / Indicate country :
Les autorités concernées / Indiquer le pays :
I actually would like to change flag.
I would like to register my boat in (indicate country) :
Je souhaite effectivement changer de pavillon.
Je souhaite immatriculer mon bateau en (indiquer le pays) :
Place :
Date :
Signature :