Ship S Declaration Port of Klaipeda Seaportauthority

SHIP’S DECLARATION PORT OF KLAIPEDA SEAPORTAUTHORITY

Ship’s name / Call sign / Ship’s flag / Reference №
Ship’s certificate (port,date,№) / Stevedoring company(ies)……………………………………………………………………...
…………………………………………………………………………………………………………………………………………………………………………………………………… / Port authority №
IMO-№ / Date and time of declaration / Home port / Voyage №
Shipping agent (name,address,tel №,fax №) / Customer №
Shipping line (License № and date of expire ) / №
Ship’s owner/ charterer / №
Liner/Tramp service / Ship’s type / LOA (m) / WOA (m) / Summer draught (m) / GT / NRT / Volume m3
ARRIVAL / № of crew / Actual draught (m)
Fwd: Aft: / Date and time of arrival / Berth:
CUSTOMS / Customs declaration № : / Date and time of customs clearance:
DOCUMENTS / Cargo declaration / Passenger list / Crew list / Ship’s store declaration / Customs declaration / Maritime declaration of health
Port of origin of cargo / Last port of call / Country / Cargo handling
Operation commenced:
Intermediate ports (in chronological sequence)
Type of cargo (Text) / Code / Quantity of cargo / Passengers / Arrived with cargo
Number of unit / Gross weight (T)
/ not to be discharged
/ completely discharged
/ partly discharged
/ in ballast or empty
/ repair

Shifting

/ From berth № date: time: to berth № date: time:
From berth № date: time: to berth № date : time:
From berth № date: time: to berth № date: time:
From berth № date: time: to berth № date: time:
From berth № date: time: to berth № date: time:
DEPARTURE / № of crew / Actual draught (m)
Fwd: Aft: / Date and time of departure / Berth
CUSTOMS / Customs declaration № / Date and time of customs clearance:
DOCUMENTS / Cargo declaration / Passenger list / Crew list / Ship’s store declaration / Customs declaration / Maritime declaration of health
Port of destination / Next port / Country / Cargo handling
Operation completed
Intermediate ports (in chronological sequence)
Type of cargo (text) / Code / Quantity of cargo / Passengers / Sailed with cargo
Completely new loaded
Number of unit / Gross weight (T)
/ Partly new loaded
/ Not changed after arrival
/ In ballast or empty
/ Repair
Remarks: / NSS watchkeeper
Authorized agent or other person (name and signature) / Master