SHIP PRE ARRIVAL INFORMATION
(SOLAS REGULATION XI-2/9 AND ARTICLE 6.3 OF REGULATION (EC) No. 725/2004)
ALL SHIPS TO SUBMIT THIS FORM TO THE PORT FACILITY SECURITY OFFICER OF THE PORT OF
ARRIVAL PRIOR TO ENTRY INTO THE PORT FACILITY IN THE REPUBLIC OF CYPRUS 1
Particulars of the ship and contact details
IMO number Name of Ship
Port of registry Flag State
Type of ship Call sign
Inmarsat call
Gross tonnage
numbers
Name of
CSO name
company
Company
CSO 24 hour
identification
contact details
number
Port Facility of
Port of Arrival
Arrival (if known)
Port and port facility information
Expected date and time of arrival in port
Purpose / duration of call
(eta)
Information required by SOLAS regulation XI-2/9.2.1
NO (give Issued by Expiry
Does the ship have a valid International reasons) date
YES
Ship Security Certificate (ISSC)? (dd/mm/yyy
y)
Does the ship have a valid Interim
International Ship Security Certificate YES
(IISSC)?
YE Security Level at which LEVEL LEVEL
NO LEVEL 2
Does the ship have an S 1 3
the ship is currently
approved SSP on board?
operating?
Location of ship at the time this report is
made
List the last ten calls at port facilities in chronological order (most recent call
first):
Date to UN LOCODE Securit
Date from Country Port facility
No. (dd/mm/yyy Port Compulsory y Level
(dd/mm/yyyy)
y)
1 SL =_
2 SL =_
3 SL =_
4 SL =_
5 SL =_
1
At least 24 hours in advance; or (b) at the latest, at the time the ship leaves the previous port, if the
voyage time is less than 24 hours; or (c) if the port of call is not known or if it is changed during the
voyage, as soon as the port of call becomes known (Chapter XI-2, Regulation 9, Control and Compliance
Measures)
Failure to submit this information in time (as stated above), control and compliance measures
will be taken such as inspection of the ship, delaying of the ship, detention of the ship,
restriction of operations, including movement within the port including expulsion from the port.
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SHIP PRE ARRIVAL INFORMATION
6 SL =_
7 SL =_
8 SL =_
9 SL =_
10 SL =_
Did the ship take any special or additional security measures,
YES NO
beyond those in the approved SSP?
If the answer is YES, indicate below the special or additional security measures taken by the
ship
No. (as above) Special or additional security measures taken by the ship
1
2
3
4
5
6
List the ship-to-ship activities, in chronological order (most recent first), which
have been carried out during the period of the last ten calls at port facilities listed
above. Expand table below or continue on separate page if necessary – insert
total number of ship-to-ship activities:
Have the ship security procedures specified in the approved
SSP been maintained during each of these ship-to-ship YES NO
activities?
If NO, provide details of the security measures applied in lieu in the final column below.
Date Location or
from Date to Ship-to-ship Security measures
No. Longitude
(dd/mm/yyy (dd/mm/yyyy) activity applied in lieu
and Latitude
y)
1
2
3
4
5
6
General description of the cargo aboard
the ship
Is the ship carrying any dangerous substances as cargo covered
by any of Classes 1, 2.1, 2.3, 3, 4.1, 5.1, 6.1, 6.2, 7 or 8 of the YES NO
IMDG Code?
If YES, confirm Dangerous Goods Manifest (or relevant extract) is attached
Confirm a copy of ship’s crew Confirm a copy of the ship’s
YES YES
list is attached passenger list is attached
Other security related information
Is there any security-related matter you wish to
YES NO
report?
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SHIP PRE ARRIVAL INFORMATION
If YES Provide details:
Agent of ship at intended port of arrival
Name: Contact details (Tel. no.):
Identification of person providing the information
Ship´s
Title or Position (tick as
MASTER SSO CSO agent (as
appropriate):
above)
Name: Signature:
Date/Time/Place of completion of
report
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