Port Departure Tax Payment Form
Please complete this form to provide departure details and pay the required port departure tax.
Full Name of Responsible Person
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Vessel Name or Identification
*
Type of Vessel
*
Please Select
Cargo Ship
Passenger Ship
Fishing Boat
Yacht
Other
Port of Departure
*
Please Select
Port A
Port B
Port C
Other
Destination Port or Location
*
Scheduled Departure Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Number of Passengers or Crew On Board
*
Vessel Registration or Documentation Number
Departure Tax Payment
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Name: A to Z
Name: Z to A
Price: Low to High
Price: High to Low
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Port Departure Tax
Mandatory tax for vessels departing the port. Amount may vary by vessel type or size.
$100.00
$
100.00
Vessel Size
Small (up to 20m)
Medium (20-50m)
Large (over 50m)
Â
Â
Signature of Responsible Person
*
Submit & Pay
Submit & Pay
Should be Empty: