Owner/Operator Tax Identification Number (TIN):
Name Of Applicant:*
Location Of Inspection:*
Proposed Inspection Date:*
Second Proposed Inspection Date:
Certificate Of Inspection Issue Date:
Certificate Of Inspection Expiration Date:
Is the vessel
enrolled in the Alternate Compliance Program (ACP):
Is the vessel enrolled in the Maritime Security Program
As required by 46 CFR 2.10-120, applicants requesting an overseas inspection must remit an overseas inspection fee payment of $4585 at the time of the request. The overseas inspection fee is not required for vessels inspected in Mexico.
Has the Overseas Inspection Fee been paid:*
Payment of the $4,585 Overseas Inspection Fee can be made using one of three
1. Check or money order, drawn on a U.S. bank and made payable to the
"U.S. Treasury." Checks or money orders can be sent to our office
by express courier (i.e. Fedex) to: US Coast Guard, Sector New Orleans, ATTN: Rob Holzman, 200 Hendee ST, New Orleans LA 70112
2. Wire transfer. If wiring funds, please send wire fund transfer confirmation to Robert.S.Holzman@uscg.mil
3. Charged to Visa or MasterCard Credit Card.
Instructions and forms for remitting payment by wire transfer or credit card
can be found on the U.S. Coast Guard Finance Center web site:
All fees must be remitted in U.S. currency. Please include the vessel name and official number on the desired form of payment or your deposit will not be associated with the inspection.
In addition to the Overseas Inspection Fee, the applicant is responsible
for reimbursing the U.S. government the cost of travel to and from the location
of the inspection, lodging, and daily expenses.
If you have any questions concerning this Request for Inspection Form please send inquiries to the Sector New Orleans Overseas Inspections division.
* Required Field