ACI marina Pomer, Pomer 26/A, HR-52100 Pula, Tel: +385 52 573 162

ZAHTJEV ZA VEZ REQUEST FOR A BERTH

ANFRAGE LIEGEPLATZ RICHIESTA D'ORMEGGIO
IME PLOVILA

(S/Y, M/Y, KAT) : ________________________________________________________________________

NAME OF VESSEL BOOTSNAME NOME DELL' IMBARCAZIONE

PROIZVOA I MODEL : __________________________________________________________________________________

MAKE & MODEL OF VESSEL HERSTELLER & FAHRZEUGTYP DITTA COSTRUTTRICE E MODELLO

DUINA PREKO SVEGA (m) :

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LENGHT OVERALL LNGE BER ALLES LUNGHEZZA FUORI TUTTO

GAZ MAKSIMALNI (m) :

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DRAFT TIEFGANG PESCAGGIO

GODINA GRADNJE : _______________________________________________________________________________________

YEAR BUILT BAUJAHR ANNO DI COSTRUZIONE

ZASTAVA : __________________________________________________________________________________________________
FLAG FLAGGE BANDIERA

MATERIJAL GRADNJE : ___________________________________________________________________________________

CONSTRUCTION MATERIAL RUMPFBAUSTOFF MATERIALE DI COSTRUZIONE

VLASNIK PLOVILA :

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OWNER OF THE VESSEL EIGENTMER PROPRIETARIO

ADRESA : ___________________________________________________________________________________________________
FULL ADDRESS ANSCHRIFT INDIRIZZO

TELEFON / FAX / E-MAIL : _________________________________________________________________________________

PHONE N

FAX N

ZAHTJEV ZA / REQUEST FOR / ANFRAGE FR / RICHIESTA PER :

a) GODINJI VEZ / ANNUAL BERTH / JRLICHER LIEGEPLATZ / ORMEGGIO ANNUALE
b) MJESENI VEZ / MONTHLY BERTH / MONATLICHER LIEGEPLATZ / ORMEGGIO MENSILE
ZAHTJEV ZA PERIOD OD __________________ DO ___________________
REQUESTED PERIOD FROM - TO ANFRAGE FR ZEITRAUM VOM - BIS RICHIESTA PER IL PERIODO DAL - AL

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(Datum / Date / Datum / Data)

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(Potpis / Signature / Unterschrift / Firma)