FORMULAIRE DE NOTIFICATION D’ARRIVEE
(PRE-ARRIVAL NOTIFICATION OF SECURITY)
TO: OFFICER IN CHARGE MARITIME SECURITY / PFSO
Fax or e-mail (consult IMO web site GISIS for Algerian port facility contact)
Pre-arrival Notification of Security for :
a)Passenger ships including high-speed passenger craft,
b)Cargo ships , including high-speed craft of 500 gross tonnage and upwards,
This form is to be submitted at least 24 hours prior to the arrival of the vessel.
1) Name of Ship: / 2) Flag: / 3) Call-sign:4) GT: / 5) Type of Ship: / 6) No. of Crew: / 7) ETA:
8) Purpose of call : Loading /Discharging /Bunkering / Shipyard / Other (delete as appropriate) if others, pls specify purpose:
9) Name of Anchorage on Port Facility your ship is bound for :
10) Name of Agent in Algeria :
Tel No: Fax No:
11) Does your ship possess a valid International Ship Security Certificate (ISSC) ? Yes / No
( Delete as appropriate) If your answer is “YES”, give details in Q12 and Q13.
12) Date of expiry of the ISSC:
13) Name of issuing authority for the ISSC:
14) Current security level of the ship:
15) Last 10 ports of call (w.c.f from 1Jul 04), including arrival / departure dates and the security level at which the ship operated at those ports where it has conducted
a ship /port interface:
Port / Arrival / Departure / Security level
16) Were there any special or additional security measures taken during any ship/port interface at the ports mentioned in Q15? Yes / No (Delete as appropriate) if answer is”YES”, give details:
17) Were there appropriate ship security measures maintained during any ship to ship activity interface at the ports mentioned in Q15? Yes / No (Delete as appropriate) if answer is “YES”, give details:
SIGNATURE OF THE MASTER / OWNER / AGENT :
NAME OF THE MASTER /OWNER /AGENT
DATE(UTC):
TIME (UTC) :
PRESENT POSITION :
(lattitude) N(long tade) K/W