Cert 5201

APPLICATION FOR INTERNATIONAL CERTIFICATE

ICC
FOR OPERATORS OF PLEASURE CRAFT
Royal Yachting Association RYA House Ensign Way Hamble Southampton SO31 4YA
Tel: 023 8060 4100 Fax: 023 8060 4299 Web: www.rya.org.uk

NOT AN RYA MEMBER?

The ICC is issued free of charge to RYA members Personal membership costs no

NOT more than the certificate issue

fee if you pay by Direct Debit or
Credit Card. Please complete
PLEASE WRITE
APPLICANT’S NAME
ON BACK OF PHOTO
JOIN USING THIS FORM AND WE’LL ISSUE and return the membership form AND CLIP ON HERE
on page four to receive your
YOUR CERTIFICATE FREE OF CHARGE certificate for free.

The UK ICC issued by the RYA is issued in conformity with Resolution No. 40 of the Please allow 21 days for the certificate to be
United Nations Economic Commission for Europe (UNECE) Working Party on Inland Water issued. Regrettably we are unable to respond
Transport. The certificate is available to a person who fulfils the following eligibility criteria: to requests to check the progress of your
• has reached the age of 16; ICC application within the first 14 days of this
• is physically and mentally fit to operate a pleasure craft, and in particular, has sufficient period. If you require your ICC sooner a Fast
powers of vision and hearing; Track Service, which guarantees a 2 working
• presents one of the specified UK certificates or has successfully passed an examination to day turnaround from the date we receive your
prove the necessary competence for pleasure craft operation (see sections 4 - 6); and application, is available. Please enclose the
• who demonstrates
their nationality
or residency
to show
that
their
nationality
does
not
additional fee (see section 7) and tick the Fast
preclude them from being issued with a UK ICC by the RYA (see section 2). Track box below:
Tick for FAST TRACK service.
1. APPLICANT’S DETAILS

Name: Mr/Mrs/Miss Forename Surname

Date of birth: Country of birth: Nationality:

Address:

Post code: Country:

Telephone numbers: Evening Daytime:

Mobile: Email:

2. EVIDENCE OF APPLICANT’S NATIONALITY OR RESIDENCY:

The RYA is authorised by the Maritime and Coastguard Agency (MCA) to issue a UK ICC to the nationals of any country EXCEPT individuals who are
a national of another UNECE member state which has accepted Resolution 40 and who are also resident in another UNECE member state which has
accepted Resolution 40, unless the RYA has been given written permission to do so by the Government of the relevant country.
The other countries that have accepted Resolution 40 are: Austria; Belarus; Belgium; Bulgaria; Croatia; Czech Republic; Finland; Germany; Hungary; ,UHODQG
The countries that have accepted Resolution 40 but have not given the RYA permission to issue a UK ICC to their nationals are: Austria; Belarus;
Latvia; Lithuania; Luxembourg; Netherlands; Norway; Poland; Romania; Serbia; Slovakia; Switzerland; Ukraine. This list
Belgium; Bulgaria; Croatia; Czech Republic; Finland; Germany; Hungary; Ireland; Latvia; Lithuania; Luxembourg; Norway; Romania; Slovakia;
.rya.org.uk/go/icc-no information about any
Switzerland. This list (correct at 01.06.2015) is subject to change without notice. Please visit www.rya.org.uk/go/icc-no to consult the latest list

You must demonstrate that you are not a national of and resident in a country on this list. Please tick one option:


Option 1: If you are an existing RYA member, British resident at the address above and already paying your membership subscription by

Direct Debit from your British bank account, you do not need to send any additional evidence of your nationality or address; OR

Option 2: If you are a national of a country which is not on the list you can send a copy of the photo page of your passport or a
recognised national identity card showing your nationality; OR
Option 3: If your address above is in a country which is not on the list you can send evidence that you are resident at this address.
Send a copy of a recent utility bill or bank statement, a driving licence, a recognised national identity card or other

official document, showing your name and address. Further authenticated evidence may be requested.

3. declaration & signature of applicant

3. DECLARATION & SIGNATURE OF APPLICANT:
I confirm that I satisfy the eligibility criteria above and I understand that:
• the UK ICC issued by the RYA is issued under the authorisation and on behalf of •• the RYA will process the personal data I have given for the purpose of
the UK Maritime and Coastguard Agency (MCA); fulfilling this contract with me. My personal data will be processed in line
• possession of this certificate does not entitle me to a certificate issued on behalf of with the RYA privacy policy www.rya.org.uk/go/privacy
any other organisation or any other national Government;
• the certificate is valid for 5 years from the date of issue; should my eligibility
change during the period the ICC is valid for I must notify the RYA and surrender SIGNATURE OF APPLICANT:
the document and will not be entitled to any refund;
• if I cannot satisfactorily demonstrate my continued eligibility when the certificate
expires it will not be renewed by the RYA;
• the acceptance of the ICC is determined in accordance with both the vessel’s flag
state legislation and that of the country in which the vessel is to be used and that it
is my responsibility to ensure that the ICC is acceptable for its intended use; and

Please ensure Sections 4 & 7 are completed before submitting your application April 2019
 4. EVIDENCE OF APPLICANT’S COMPETENCE To be completed by the applicant
4. EVIDENCE OF APPLICANT’S COMPETENCE To be completed by the applicant

Evidence
Evidence
of your
of your
competence
competence
mustmust
be provided
be provided
for each
for each
category
category
you you
require
require
validated
validated
on your
on your
ICC.ICC.
Please
Please
indicate
indicate
the ICC
the ICC
categories
categories
you you
are are
applying
applying
for and
for and
the evidence
the evidence
of competence
of competence
you you enclosing.
are enclosing: You must tick at least one box in each of lists 1 and 2 below:
are enclosing:
CATEGORY
CATEGORY TICK BOX IF
TICK BOX IF EVIDENCE
CATEGORY
CATEGORY NOTES
NOTES
REQUIRED
REQUIRED

Coastal
Coastal
Coastal This
ThisThis category
category
category willvalidated
will be
will bevalidated
be validated
unlessunless
unless courses
courses
courses / /assessments
assessments
/ assessments have
havehave been
beenbeen conducted
conducted
conductedon onon
waters
waters inland waters
inland or the
waters or certificate you you
the certificate are presenting doesdoes
are presenting not demonstrate competence
not demonstrate competence to to
skipper a boat
skipper in coastal
a boat waters
in coastal e.g. e.g.
waters RYARYAHelmsman’s
Helmsman’s Course Completion
Course Certificate
Completion or or
Certificate
LIST 1

MCA
MCAMCA Tier 2 Boatmaster
Boatmaster
BoatmasterCertificate qualifications
Certificate

Inland
Inland
Inland Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box: MustMust
be supported
be supported
by by
waters
waters Enclose
Enclose
Enclose print
printprint
out toout
out totoshow
show show CEVNI
CEVNI
CEVNI testpassed
test test
passedpassed or or
online;
online;
online; or RYARYA
Practical
Practical
certificate
certificate
Affiliated ClubClub
Affiliated or Recognised Training
or Recognised Centre
Training to sign
Centre off CEVNI
to sign test test
off CEVNI in section 5 5
in section or ICC
or ICC
Assessment.
Assessment.

Sail Sail
Sail Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box: The The
powerpower category
category
power will will
category will
(including
(including RYARYA
RYA
DayDaySkipper
DaySkipper
Skipper
Sail Sail
(Practical)
Sail(Practical)
(Practical)
or Coastal
orCoastal
or Coastal
Skipper
Skipper
Sail Sail
Skipper (Practical)
Sail(Practical)
(Practical)
Course
Course
Course alsoalso be validated
be validated
validatedwithwith
the the
with the
auxiliary
auxiliary Completion Certificate;
Completion or or
Certificate; or Certificate No: …………………………… “up10m
“up to to 10m
length
10m length
length overall”
overall”
overall”
engine)
engine) RYA/MCA
RYA/MCA
RYA/MCA Coastal
Coastal
Skipper
Coastal Skipper
or Yachtmaster®
Skipper orYachtmaster®
or Yachtmaster®
Sail Sail
(coastal,
Sail(coastal,
(coastal,
offshore
offshore
or ocean)
offshore orocean)
or ocean) restriction
restriction to
to allow
to allow
restriction youyou
allow you
Certificate of Competence;
Certificate of Competence; or oror Certificate No: …………………………… to drive
to drive aa tender
a tender
drive withwith
tender an an
with an
RYARYA
RYA
ICC ICC
assessment
ICCassessment
assessment
aboardaboard
a sailing
aboard aasailing
sailing
yacht yacht
withwith
yacht with
auxiliary
auxiliary
engine
auxiliary signed
engine off inoffsection
signed in section
5 5 outboard
outboard etc.etc.
outboard etc.

PowerPower Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box: The The
ICC’sICC’s validity
validity for for
(validity
(validity RYARYAPowerboat
Powerboat Level 2 or 2higher
Level Course
or higher CourseCompletion
Completion Certificate (the (the
Certificate ICC ICCwill only be be
will only powerpower driven
driven vessels
vessels will will
maymaybe be validvalid
for vessels up toup10m
for vessels to 10mLOA; certificates
LOA; fromfrom
certificates inland courses
inland coursesdo not do validate the the
not validate be restricted
be restricted to vessels
to vessels
restricted
restricted to to coastal
coastal waters
coastal waters
waters or or
category);
category);
category); or Certificate No: …………………………… “up10m
“up to to 10m
LOA” LOA”
if theif the
10m10mLOALOA RYARYARYA
DayDay DaySkipper
Skipper
Skipper Motor Motor (Practical)
(Practical)
Motor (Practical) orCoastal
or Coastal
or Coastal
SkipperSkipper
Motor
Skipper Motor (Practical)
(Practical)
Motor (Practical) CourseCourse
Course evidence
evidence provided
provided is anis an
see see notes)
notes) Completion
CompletionCertificate; or or
Certificate; or Certificate No: …………………………… RYARYA Powerboat
Powerboat Course Course
RYA/MCA
RYA/MCA
RYA/MCA Coastal
Coastal Skipper
Skipper
Coastal Skipper orYachtmaster®
Yachtmaster®
or Yachtmaster®
or Power Power
Power (coastal,
(coastal, offshore
(coastal, offshore
offshore orocean)
or ocean)
or ocean) Completion
Completion Certificate
Certificateor if or if
Certificate of Competence;
Certificate of Competence; or or or Certificate No: …………………………… or
theifRYA
the RYA the
ICCRYA
ICC ICC
assessment
assessment
Advanced
Advanced Powerboat
Powerboat RYA/MCA
RYA/MCA Certificate of Competence;
Certificate of Competence; or or has assessment
has
beenbeentaken has
taken
at a atbeen
a
For RYA
For RYA RYARYAInland Waterways
Inland Waterways Helmsman
Helmsman Course
CourseCompletion
Completion Certificate
Certificate(does not validate
(does not validate taken
powerboat atrecognised
powerboat a powerboat
recognised
HQ internal
HQ internal thecoastal
the coastal
the coastal
waterswaters category);
category);
waters category);or or or Certificate No: …………………………… recognised
training
training
centre training
centre
or onoraon power
a power
use use
only:only: RYARYAHelmsman’s
Helmsman’s Course Completion
Course Completion Certificate (does
Certificate not validate
(does not validate the coastal waters
the coastal waters boatcentre
boat
or a orora on
motormotora power
cruisercruiser
of of
LIST 2

Certificate
Certificate category);
category); or or
category); or Certificate No: …………………………… underboat
under
10m or10m
a motor
LOA. LOA.cruiser
to betoissued
be issued MCAMCA Deck Officer
Deck Certificate
Officer of Competence
Certificate of Competence (any(any
grade); or or
grade); or of under 10m LOA.
with with
powerpower RN, RN,
Army or RAF
Army Bridge
or RAF Watchkeeping
Bridge Watchkeeping Certificate; or or
Certificate; or
category
category MCAMCAMCA orLocal
or Local
or Local Authority
Authority
Authority Boatman’s
Boatman’s
Boatman’s or or
Licence;
Licence;
Licence; or
restricted
restricted MCAMCA Boatmaster
BoatmasterCertificate (does
Certificate (Tier
not 1
(does Level
validate
not 1the
and
validate Tier
coastal
the 2 waters
coastaldo not
waters validate
category); theorcoastal
category); or
to vessels
to vessels waters category); Seafish Bridge Watchkeeping Certificate; or
up toup to 10m RYA
section 5)ICC
section 5) assessment
(the ICC ICC
(the will aboard
will only be avalid
be valid
only power
for for boat
vessels or motor
up
vessels to cruiser
toup10m LOALOA
10m if (to
theifbe
RYA
thesigned off in
ICC ICC
RYA
10mLOA
10m
LOALOA section 5)
assessment
assessment has(the
been
has ICC willtaken
taken
been only be
at a at avalid
powerboat for recognised
powerboat vessels up to
recognised 10m
training LOA
centre
training if the RYA
or on
centre oraonICC
power
a power
assessment has been taken at a powerboat recognised training centre or on a power
boatboat
or a or
motor cruiser
a motor of under
cruiser 10m10m
of under LOA) LOA)
boat or a motor cruiser of under 10m LOA)
Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box:
Provide a copy of one of the following and tick the relevant box: There
There is noisICC
no ICC
Personal
Personal
Personal RYARYA
Personal Watercraft
Personal Proficiency
Watercraft Certificate;
Proficiency Certificate; or Certificate No:…………………… assessment
or or assessmentfor for
watercraft
watercraft RYARYA
Powerboat Level
Powerboat 2 or 2higher
Level Course
or higher Completion
Course Certificate;
Completion or or
Certificate; or Personal
Personal Watercraft
Watercraft
Advanced Powerboat
Advanced RYA/MCA
Powerboat RYA/MCA Certificate of Competence
Certificate of Competence

Please provide the Certificate number for your evidence of practical competence
5. ICC ASSESSMENT OF COMPETENCE AND ICC CEVNI TEST To be completed by the Affiliated Club or Recognised Training Centre (RTC)
5. ICC ASSESSMENT OF COMPETENCE AND ICC CEVNI TEST To be completed by the Affiliated Club or Recognised Training Centre (RTC)
5. ICC ASSESSMENT OF COMPETENCE AND ICC CEVNI TEST To be completed by the Club or Recognised Training Centre (RTC)
The The
ICC ICC
Assessment
Assessment
is only
is only
applicable
applicable
to candidates
to candidates
without
without
acceptable
acceptable
UK Certificates
UK Certificates
(see(see
section
section
4) and
4) and
is notisapplicable
not applicable
to the
toPersonal
the Personal
Watercraft
Watercraft
category.
category.

We hereby
We hereby
confirm
confirm
that that
the applicant
the applicant
has has
successfully
successfully
demonstrated
demonstrated
theirtheir
skillsskills
and and
knowledge
knowledgein accordance
in accordance
withwith
the ICC
the ICC
Assessment
Assessment
of of
Competence
ICC Competence
Syllabus
ASSESSMENT Syllabus
OFasCOMPETENCE
follows:
as follows:
(Please
(Please
ensure
ensure
PASSED tick tick
boxes
at Club boxes
orinRTC
Section
in Section
6 are
Name: 6 completed
are completedin full)
in full)
W Assessment of
ICC ASSESSMENT OF COMPETENCE PASSED at Club or RTC Name:
ICC ASSESSMENT OF COMPETENCE PASSED at Club or RTC Name:
Competence Syllabus as follows: (Please ensure tick boxes in Section 6 are completed in full)
Type of vessel(s) used for test:
Type of vessel(s) used for test: Length (LOA m):
Length (LOA m):
Type of vessel(s) used for test: Length (LOA m):
Tested for categories: (please
Tested for categories: (please
tick relevant
tick relevant
boxes)
boxes) Power
Powerup toup10m to 10m
LOALOA Power Power
10m10m
LOALOA
and and
overover Sail Sail
(including Also validates
(including Also validates
powerpower
Tested for categories: (please tick relevant boxes) Power up to 10m LOA Power 10m LOA and over Also validates
Sail (including categorycategory power
with the
with
“up
theto“up to
Test conducted on: (please
Test conducted on: (please
tick relevant
tick relevant
boxes)
boxes) Coastal
CoastalWatersWaters Inland
Inland
Waters
Waters auxiliary
auxiliary
engine)
engine)
category
10m 10mwith
LOA” LOA”therestriction.
“up to
restriction.
Test conducted for: (please tick relevant boxes) Coastal Waters Inland Waters auxiliary engine) 10m LOA” restriction.
Test conducted by:
Test conducted by: Approved by (Flag Officer or Principal):
Approved by (Flag Officer or Principal):
Test conducted by: Approved by (Principal, Chief Instructor or Flag Officer):
Name:
Name: Name:
Name:
Name: Name:
Applicable
Applicable
RYARYA
qualification(s)
qualification(s)
held:held: Signature:
Signature:
Applicable R Signature:
Signature:
Signature: Date:
Date: Date:
Date:
Signature: Date: Date:

ICC ICC
CEVNI
CEVNI
TEST TEST
PASSED at Club
PASSED at Club
or RTC Name:
or RTC Name: . We. hereby
We hereby
ICC CEVNI TEST PASSED at Club or RTC Name: . We hereby
confirm
confirm
that that
the applicant
the applicant
has has
successfully
successfully
demonstrated
demonstrated
understanding
understanding of CEVNI
of CEVNI (European
(European
CodeCode
for Inland
for Inland
Waterways)
Waterways)
passing
passing
the CEVNI
the CEVNI
test.test.
aterways) passing the CEVNI test.
Test conducted by:
Test conducted by: Approved by (Flag Officer or Principal):
Approved by (Flag Officer or Principal):
Test conducted by: Approved by (Principal, Chief Instructor or Flag Officer):
Name:
Name: Name:
Name:
Name: Name:
Signature:
Signature: Date:
Date: Signature:
Signature: Date:
Date:
Signature: Date: Signature: Date:
 6. SYLLABUS FOR ICC ASSESSMENT OF COMPETENCE To be completed by the Affiliated Club or Recognised Training Centre (RTC)

ORAL / WRITTEN ELEMENTS PRACTICAL ELEMENTS

ALL CANDIDATES ALL CANDIDATES

Regulations 2
WIND
1. Knows responsibility for keeping a proper lookout 1
2. Can determine a ‘safe speed’ PONTOON 3

3. Can recognise a potential collision situation

4. Can identify ‘give way’ vessel in a collision situation
5. Knows what action to take as ‘give way’ and ‘stand on’ vessel
6. Knows responsibilities of a small vessel in a narrow channel
6b 6a 4
7. Can recognise manoeuvring signals (1.2.3 & 5 short blasts)
8. Can make and recognise visual distress signals

Safety
1. Is able to use and instruct crew on the use of:
• Life jackets
• Distress alerting (e.g. DSC VHF, EPIRB, Flares, etc.)
• Fire extinguishers 5
• Kill cord (if fitted)
2. Can prepare a boat for use and take sensible 1. Start
precautions before setting out, including: • Give safety briefing including use of safety equipment
• Engine checks • Has listened to weather forecasts
• Check fuel for range / duration of trip • Pre start engine checks
• Obtain weather forecast • Use kill cord (if fitted)
• Avoid overloading boat • Start engine
• Check cooling
• Knows fuel range
CANDIDATES FOR COASTAL WATERS ONLY
2. Depart from Pontoon
• Understands use of springs to depart from lee wall/pontoon
Regulations
• Communicate with crew
1. Knows rules relating to Traffic Separation Schemes • Position fenders correctly
2. Knows requirements for navigation lights and shapes to be 3. 360° Turn in Confined Space
displayed by own vessel
4. Securing to Buoy
3. Can recognise the following from the lights: Power driven, sailing • Communicate effectively with crew
vessel, vessel at anchor, tug and tow, fishing vessel, dredger • Prepare warp
• Choose correct angle of approach
4. Knows sound signal to be made by vessels as in Q3
• Control speed of approach
• Secure boat effectively
Navigation (Chart & Plotting Instruments required) • Depart from the mooring safely
1. Can interpret a navigational chart, understand significance of 5. Man Overboard
charted depths and drying heights and can identify charted hazards • Observe MOB or instruct crew to do so
• Demonstrate correct direction and speed of approach
2. Can plot position by cross bearings and by latitude / longitude
• Make suitable contact with MOB
3. Can determine magnetic course to steer, making allowances for
6a. Planning Speed Manoeuvres (if appropriate)
leeway and tidal stream
• Choose suitable area
4. Can use a tide table to find times and heights of high and low • Show awareness of other water users
water at a standard port • Warn crew before each manoeuvre
• Look around before S and U turns
5. Can determine direction and rate of tidal stream from a tidal
• Control speed on U turns
stream atlas or tidal diamonds on a chart
6b. Handling Under Sail (if appropriate)
6. Understands basic use of GPS
• Sail triangular course with one leg to windward
• Choose suitable area for hoisting/lowering sails
Pilotage • Use sails suitable for prevailing conditions
• Show awareness of wind direction
1. Can recognise, by day and night, and understand significance of
• Trim sails correctly on each point of sailing
buoys of the IALA system
• Warn crew before manoeuvres
2. Knows sources of information on: local regulations, port entry and • Look round before tacking and gybing
departure signals, VTS and Port Operations Radio • Control sails during tacking and gybing
3. Can plan a harbour entry/departure, taking account of possible 7. Coming Alongside Windward Pontoon
presence of large vessels and avoiding navigational hazards • Communicate effectively with crew
• Show awareness of other water users
• Prepare warps/fenders
• Choose correct angle of approach
• Control speed of approach
• Stop boat in place required and secure to pontoon
• Stop engine
 7. CHARGES RYA MEMBERSHIP FORM
(Please tick the appropriate box below)
EXISTING RYA MEMBER. As a member Cost of Fast Track (if required) £21. New members paying by direct debit and requiring the
you receive the ICC free of charge. fast track service must make a separate payment for the fast track fee by cheque payable to
Membership No. _______________ ‘RYA’, postal order, credit or debit card.
Cost of Fast Track for existing members (if
required) £21 for standard members, £16 for Title Forename Surname Gender

MEMBER 1
accredited members or £10 for gold members. M F
Free of charge to life members. Payment for the fast
Date of Birth Email Address
track fee is required with your application and can be
made by cheque payable to ‘RYA’, postal order, credit
or debit card only. Direct debit is for new membership Title Forename Surname Gender
applications only.

MEMBER 2
M F
BECOME A RYA MEMBER. Date of Birth Email Address
Please complete the form and as
a new member you receive the
ICC free of charge Title Forename Surname Gender

MEMBER 3
M F
NON-MEMBER. As a non-member,
Date of Birth Email Address
the cost of the issue for the ICC is £45.
Cost of Fast Track for non-members (if
required) £3. Payment for the fast track fee and Title Forename Surname Gender
MEMBER 4

the certificate issue are required with your application M F

and can be made by cheque payable to ‘RYA’, postal
Date of Birth Email Address
order, credit or debit card only. Direct debit is for new
membership applications only.
All Fast Track applications are returned by Royal
Mail First Class post (UK) and Royal Mail Air Mail ADDRESS
(Overseas). If you require a tracked service an
additional fee of £10.00 is required. Postcode

8. PAYMENT Home Tel Mobile Tel

(Please tick the boxes that apply and
indicate the total amount payable) Category of Pathway For those who have just discovered boating
membership, Personal For recreational boaters
ICC Fee – non-members £45
tick one box. Associate For boaters who are members of an RYA affiliated club or class
Fast Track Fee – non-members £3
Club or class name:
Fast Track Fee – standard members £21
Accredited For RYA instructors, race officials and more*
Fast Track Fee – accredited members £16
*Accredited membership also includes appointed RYA race coach level 2 and 3, commercial endorsement holders, British Youth Sailing
Fast Track Fee – gold members £10 Programme and World Class Programme Sailors.
Fast Track Fee – life members free of charge
Tracked Service – £10 (Fast Tracks only) Type of membership Under 18 £15 by direct debit or card, £17 cash or cheque
required, please tick one box. Under 25 £25 by direct debit or card, £27 cash or cheque
Membership Subscription Prices shown are costs of Adult £45 by direct debit or card, £47 cash or cheque
Under 18 £15/£17 Under 25 £25/£27 annual subscription Family* £70 by direct debit or card, £72 cash or cheque
Personal £45/£47 Family £70/£72
*Family Membership: Two adults plus under 18’s living at the same address. Prices valid until 31/03/2020.
TOTAL AMOUNT: £ Please number up to three boating interests in order, with number one being your principal interest.
Yacht Racing Yacht Cruising Dinghy Racing Dinghy Cruising Personal Watercraft Sportsboats & RIBS
9. CARD DETAILS (if required) Windsurfing Motor Boating Powerboat Racing Canal Cruising River Cruising

Your card details are not stored on any RYA
systems and are securely destroyed once
payment has been processed.
Please debit my Visa / Mastercard / Switch /
this form records your personal data for RYA membership. The data recorded on this form will be verified by the RYA and
transferred onto the central database. Your data will be used to verify your membership and communicate relevant information
about your membership such as your welcome pack and renewal documents.
The RYA will process the personal data you have given for the purpose of fulfilling this contact with you.
Your personal data will be processed in line with our privacy policy www.rya.org.uk/go/privacy.

Maestro (delete as applicable) card Signature Source Code

Card Number

Date Joining Point Code if applicable

Membership payments can be made by direct debit, cheque payable to ‘RYA’, postal order, credit or debit card.
Card Start Date Card Expiry Date
PAY MEMBERSHIP BY DIRECT DEBIT AND SAVE MONEY
Switch Issue No. Card Security No.
Instruction to your Bank or
Building Society to pay by Direct Debit
Cardholder’s Name Name and full postal address of your Bank/Building Society Originator’s Identification Number
To The Manager Bank/Building Society
9 5 5 2 1 3
Cardholder’s Signature Address
RYA Membership Number (For office use only)

10. CHECK LIST Instruction to your Bank or Building Society

Application form completed in full and
declaration signed
Evidence of your nationality or residency enclosed
Evidence of competence enclosed and / or
sections 4 and / or 5 completed
Passport sized photograph with name on
reverse attached
Fast track service requested if required
Payment enclosed
Please pay Royal Yachting Association Direct Debits from the account detailed in
this instruction subject to the safeguards assured by The Direct Debit Guarantee.
Postcode
I understand that this instruction may remain with the Royal Yachting Association
and, if so details will be passed electronically to my Bank/Building Society.
Name(s) of account holder(s)
Signature(s)
Branch sort code
Bank/Building Society account number
Date

Send to: RYA Certification, RYA House,

Ensign Way, Hamble, Southampton, SO31 4YA Banks and Building Societies may not accept Direct Debit instructions for some types of account.