Rescue Co-ordination Centre (RCC) Bermuda

Government of Bermuda
Department of Marine & Ports Services
9 Fort George Hill, St. George's, Bermuda GE02
Telephone : (441) 297-1010 Facsimile : (441) 297-1530
Telex : (581) 431010110 RCCB X
E-mail : operations@rccbermuda.bm
WWW : http://www.rccbermuda.bm


Bermuda 406 MHz ELT Registration Form

Aircraft Information

1. Aircraft Type : 2. Registration :

3. Serial No. : 4. Airline Location :

5. Max No. Persons : 6. Radio Call Sign :

7. Satellite Contact Nos. :

8. ACARS Fitted (circle) : Yes No 9. Mode S Code :

10. Aircraft Colours :

ELT Information 15 character Hexadecimal Beacon ID (Bits 26-85 of digital message)
15
11. COSPAS / SARSAT Code

12. Manufacturer : 13. Model No :

14. Address of Supplier :

15. Telephone :

Aircraft Emergency Contact Information

16. Airline Ops 24-Hour Contact :

17. Telephone : Fax :

18. Tech Co-ordinator 24-Hour Contact :

19. Telephone (Home) : (Work) :

20. Operators Name : E-mail :

21. Mailing Address :

22. RCC Bermuda will confirm Registration. To whom should this be sent? (Name / Fax No. / e-mail)


Please return by fax or mail to the top address
All information is confidential and will be used only in the event of ELT activation


For Official Use
Received :



CSTA #

SN ..


Database updated by :

DTG :

Rev Jan 2005