Harlingen Port Authority

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1 8. Pre-arrivalset Harlingen Port Authority Pre-arrival information file for your visit to Harlingen Port during the Tall Ships Races Harlingen 0. Non-ISPS ships Pre-arrival are not information obliged to file fill for the your cels visit regarding to Harlingen security. Port See during the red the remarks! Tall Ships Races 0.. Start Non-ISPS with completing ships are not this obliged file with to fill your the details. cels regarding security. See the red remarks!. Print all pages and sign them.. Scan : the Start signed with completing pages pdf this or file jpg with format your and details. mail the file to First fill the form [Pre-arrival], several data is copied to the next pages! : Print all pages and sign them, Have a good : Scan voyage the to signed Harlingen! pages in.pdf or.jpg format and mail the file to STI STI will forward your pre-arrival information to the competent authorities Stichting Harlingen Have a good Sail voyage to Harlingen! Noorderhaven AM Harlingen Harlingen Port Authority Tel: + (0)7 88 P.O.Box HA HARLINGEN The Netherlands Tel. **

2 IMO number Port of registry Type of ship Gross tonnage Name of Company Particulars of the ship and contact details (All ships) Name of ship Flag State Call sign Inmarsat call numbers CSO name & h contact details Port and port facility information (All ships) Port of arrival NLHAR Port facility of arrival Date ETA Purpose of call Does the ship have a valid International Ship Security Certificate (ISSC) Time ETA Information required by SOLAS regulation XI -/9.. (ISPS ships only) Yes Interim If NO: Why not? Issued by Expire date Location of ship at the time this report is made List the last ten calls at port facilities in chronicle order (most recent call first) (ISPS ships only) No. Date from Date to Port Country UNLOCODE Port facility Security level Did the ship take any special or additional measures, beyond those in the approved SSP? Yes No If the answer is YES, indicate below the special or additional security measures taken by the ship No. Special or additional security measures taken by the ship

3 List the ship-to-ship activities, in chronicle 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 activities? Yes No If NO, provide details of the security measures applied in lieu in the final column below No. Date from Date to Location or Lat./Lon. Ship-to-ship activity Security measures applied in lieu General description of the cargo aboard Is the ship carrying any dangerous substances as cargo covered by any of Yes No Classes,.,.,,.,., 6., 6., 7 or 8 of the IMDG-code If YES, confirm Dangerous Goods Manifest (or relevant extract) is attached Confirm a copy of ship s crew list is attached (embedded in this document Yes No Confirm a copy of ship s passenger list is attached (as separate file) Yes No Other security related information (ISPS ships only) Is there any security-related matter you wish to report? Yes No Provide details: Agent of ship at intended port of arrival To be determined by the Tall Ships organisation (Foundation Harlingen Sail) Identification of person providing the information Title or position: Master Signature: SSO CSO Ships agent. Report completed at Date Place

4 IMO CREW LIST (IMO FAL ) (All ships). Name of Ship:. Port of Arrival /Departure: Harlingen, The Netherlands. Date of arrival/departure. Nationality of ship:. Port of Arrived from/port of destination: Nº 6. Family name, given names: 7. Rank or rating: 8. Nationality 9. Date and place of birth 0. Seaman s Passport No: Date and signature by master, authorized agent or officer: Date: Signature:

5 IMO SHIP S STORES DECLARATION (IMO FAL ) (All ships). Name of ship:. IMO number:. Call sign:. Voyage number:. Port of arrival: Harlingen, The Netherlands. Date of arrival:. Flag state of ship:. Last port of call: 6. Number of persona on board: 7. Period of stay: Nº 8. Name of article: 9. Quantity: 0. Location on board:. Official use: Date and signature by master, authorized agent or officer: Date: Signature:

6 Declaration of Security (ISPS ships only) Name of ship Port of registry IMO number Name of Port facility Harlingen, Public Quay This declaration of Security is valid from: This declaration of Security is valid until: For the following activities: Awaiting orders, repairs, supplies and laid-up vessels on an open public quay: It is prohibited to deliver ships supplies and stores or luggage on a public quay. These items have to be taken on board immediately under the SSO. The SSO is obliged to maintain watch keeping on board and to maintain a visitor s registration. At night time there has to be sufficient deck lighting, including clear visibility of the gangway. Under the following security levels: Security level(s) for the ship Security level(s) for the port facility The port facility and ship agree to the following security measures and responsibilities to ensure compliance with the requirements of Part A of the International Code for the Security of Ships end of Port Facilities. The affixing of the initials of the PFSO of SSO under these columns indicates that the activity will be done, in accordance with relevant approved plan by. Activity The port Facility The Ship Ensuring the performance of all security duties AK/EJ/AH Monitoring restricted areas to ensure that only authorized personnel have access Controlling access to the port facility Controlling access to the ship Monitoring of the port facility, including berthing areas surrounding the ship Monitoring of the ship, including berthing areas and areas surrounding the ship Handling of cargo AK/EJ/AH AK/EJ/AH Delivery of ships stores Handling Unaccompanied baggage

7 Controlling the embarkation of persons and their effects Ensuring that security communication is readily available between the ship and port facility AK/EJ/AH The signatories to this agreement certify that security measures and arrangements for both the port facility and the ship during the specified activities meet the provisions of chapter XI- and Part A of Code that will be implemented in accordance with the provisions already stipulated in their approved plan or the specific arrangements agreed to and set out in the attached annex. Dated at Harlingen, The Netherlands, on the./ /. The port facility: Signed for and on behalf of The Ship: (Signature of Port Facility Security Officer) (Signature of Master or Ship Security Officer) Name and title of person who signed Name: Name: Auke Huizenga, also on behalf of Andries Koornstra and Evert de Jong Title: Title: PFSO Nautisch Beheer Harlingen Contact details (to be completed as appropriate) (indicate the telephone numbers or the radio channels of frequencies to be used) For the port Facility For the ship Traffic centre ( hours) Captain: Phone: +(0)7- VHF Channel PFSO Office (08.00 hours 6.00 hours) Phone: +(0)7-9 +(0)7-97 Fax: +(0)7- PFSO-HB CAR ( hours) Phone: +(0)69008 Ship Security Officer ( hours) Company Security Officer ( hours) Shipping Company

8 WASTE DISPOSAL NOTIFICATION (all ships) Pursuant to the Dutch Prevention of Pollution from Ships Act (Wws) and Directive 000/9/EG, the Port Waste Plan Harlingen Port applies. By calling at these port, you are agreeing to the ensuing rights and obligations, to which general terms and conditions are applicable. The obligation to discharge applies in all the ports of the Member States of the EU. Form (English): Notification of ships waste and (remainders of) noxious substances (art. a Wvvs). This information has to be reported to Harlingen Port Authority, by means stipulated by the harbormaster. No. of crew: Gross Tonnage: Lloyds number: No. of passengers: Engine capacity: Name of ship: Port of call: Harlingen, The Netherlands ETA: h/d/m/y Call sign: Last port of call: Estimated time in port: Flag state: Next port of call: (hours/day s) Type of waste Name of substance or UN number Amount of waste to be delivered Name collector reception facility Anticipated berth of discharge Date of anticipated discharge dd-mm Maximum dedicated storage capacity Amount of waste to be retained on board Port at which remaining waste will be delivered Last port waste was delivered Date when waste was delivered dd-mm Amount of waste to be generated between notification and next port of call. Engine room (Marpol Annex I) Fuel oil residues (specify) m³ m³ m³ m³ Bilge water X m³ m³ m³ m³ Used engine oil X m³ m³ m³ m³. Accommodation (Marpol Annex IV en V) Sewage X m³ m³ m³ m³ Plastic X m³ m³ m³ m³ Food waste X m³ m³ m³ m³ Maintenance waste (specify) m³ m³ m³ m³ Domestic waste X m³ m³ m³ m³. Cargo area (Marpol Annex I, II, en V) Annex I Dirty ballest water X m³ m³ m³ m³ Annex I Oily tank washings m³ m³ m³ m³ Annex II Tank washings noxious liquid m³ m³ m³ m³ Annex II Other (specify: e.g. remainders m³ m³ m³ m³ in drums or barrels) Annex V Dry cargo residues (specify) m³ m³ m³ m³ Annex V cargo-associated waste m³ m³ m³ m³ Date and time of notification: Name of shipping agent: Signature:

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