Notice of Claim of Lien | US Vessel Documentation Service

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NOTICE OF CLAIM OF LIEN (NCL)

"*" indicates required fields

VESSEL NAME

OFFICIAL NUMBER*

HULL ID NUMBER (HID) *IF APPLICABLE

NAME OF CLAIMANT (INDIVIDUALS/ENTITIES WHO ARE OWED MONEY)

First Last

ADDRESS OF CLAIMANT (INDIVIDUALS/ENTITIES WHO ARE OWED MONEY)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

AMOUNT OF CLAIM

DATE OF CLAIM

NATURE OF LIEN CLAIMED (DESCRIBE)

ACKNOWLEDGMENT

THE INFORMATION STATED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.

AUTHORIZED SIGNATURE*

SIGNATURE (TYPE FULL NAME)

Signature*

CAPACITY (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

NOTICE OF CLAIM OF LIEN( NCL)

Price:

PLEASE SELECT ANY ADDITIONAL SERVICES YOU WISH TO ADD TO HAVE PROCESSED

Priority Request/Rush Processing

Abstract of Title

Certified Copy of COD

Total

Authorization*

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected USCG documents. I understand that my application will be processed in the order in which it is received by Vessel Registrar LLC, a private fee for service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Vessel Registrar LLC's no refund policy and as per 46 CFR 67.500(e). I understand that submitting another application for vessel documentation will supersede the current/pending application for that vessel.

Credit Card

Card Details

Cardholder Name

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BILLING ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Email*

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Phone*

Notice of Claim of Lien (NCL)

NOTICE OF CLAIM OF LIEN (NCL)