PLB Hire Information Form Form Purpose & Privacy StatementThe information provided in this form will be passed on to the Australian Maritime Safety Authority (AMSA) for the purposes of registering the PLB for the hirer's specific trip, as well as ensuring an appropriate response if the PLB is activated. Please complete it as accurately as possible and let us know if any information needs to be changed at a later date. We are diligent about protecting the personal information of our customers and always set high standards for upholding the principles of effective private information management. As such, all information collected through this PLB Hire Form (apart from responsible person's contact details) will be permanently deleted from our servers within 14 days of a PLB being returned in an appropriate condition. Any hard copies of the information will also be permanently destroyed. AMSA's privacy policy can be found here.Hirer (Responsible Person) Contact InformationFirst Name *Last Name *Phone *Email Address *Street Address *City/Town/Suburb *State *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweTrip IntentionsThis information will be registered with AMSA and used in the event of a PLB activation.Intended Area of Trip (I.e. Southwest National Park) *Intended Start Location *Intended Start Date *Intended Finish Location *Intended Finish Date *Vehicle Registration Plate (If known)Relevant Trip NotesEmergency ContactsPlease provide contact information for at least two emergency contacts who will be registered with AMSA and notified in the event of a PLB activation.Emergency Contact 1First Name *Last Name *Main Contact Number *Alternate Contact NumberRelationship to Hirer (Mother, Friend etc.) *Emergency Contact 2First Name *Last Name *Main Contact Number *Alternate Contact NumberRelationship to Hirer (Mother, Friend etc.) *Emergency Contact 3 (OPTIONAL)First NameLast NameMain Contact NumberAlternate Contact NumberRelationship to Hirer (Mother, Friend etc.)Please upload a copy of your photo ID (driver's license, passport etc.)This will speed up the PLB collection process, but if you are unable to upload that's fine as we can take a photo of your ID at collection.Choose FileNo file chosenDelete uploaded fileYes, I agree with the privacy policy and terms and conditions of hire.I understand that activation of the PLB will incur a A$300.00 battery replacement fee, and failure to return by the due date, loss of the PLB or damage to the PLB (beyond general wear and tear) will incur a A$500.00 replacement fee.Submit
