BALLAST WATER REPORTING FORM

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BALLAST WATER REPORTING FORM of Submission (DD/MM/YYYY) : //207 Time of Submission (24:00 GST) : 5:53 AMENDED FORM : SHIP INFORMATION 2 VOYAGE INFORMATION 3 BALLAST WATER USAGE AND CAPACITY Ship Name

1 BALLAST WATER REPORTING FORM of Submission (DD/MM/YYYY) : //207 Time of Submission (24:00 GST) : 5:53 AMENDED FORM : SHIP INFORMATION 2 VOYAGE INFORMATION 3 BALLAST WATER USAGE AND CAPACITY Ship Name DEMO Type of Ship GENERAL CARGO Arrival Port PORTOFARRIVAL/COUNTRY Specify Units m3 IMO Number Gross Tonnage 999 Arrival 0/0/207 Total Ballast Water Onboard Owner OWNER COMPANY Agent Last Port of Construction (DD/MM/YYYY) 20/04/99 Flag FLAG Next Port 4 BALLAST WATER MANAGEMENT Total No. of Ballast Water Tanks to be discharged Of tanks to be discharged, how many:underwent exchange: Please specify Ballast Water Management System used, if any (Manufacturer, Model): If no Ballast Water Management conducted, state reason why not: Approved Ballast Water Management Plan on board? Does Ship carry an International Ballast Water Management Certificate? were treated using a Ballast Water Management System: of issue (DD/MM/YYYY): Expiry (DD/MM/YYYY): Authority that issued Certificate : Place of issue: required to Meet Regulation D-2 (DD/MM/YYYY): 30/04/202 LASTPORT/COUNTRY NEXTPORT/COUNTRY Volume Volume Total Ballast Water Capacity No. of Tanks in Ballast Total No. of Ballast Tanks YES Management Plan implemented? YES Ballast Water Record Book on board? YES YES In compliance with MEPC 7 5 BALLAST WATER HISTORY - RECORD ALL TANKS/HOLDS containing water taken on board to control trim, list, draught, stability or stresses of the ship, regardless of ballast water discharge intentions Tanks/Holds (List multiple sources/tanks separately) FPT FDT DBT -S DBT -P DBT 2-S DBT 2-P DBT 3-S DBT 3-P AFT T-S AFT T-P ER AFT T Tank Capacity Ballast Water Sources Current Port/Position Volume Ballast Water Exchange Startpoint Position Method Endpoint Position Flow through Volume Used % Exch`d Salinity (PSU) Proposed Ballast Water Discharge Port/Position Volume Salinity (PSU) Ballast Water Tank Codes: Forepeak=FP, Aftpeak=AP, Double Bottom=DB, Wing=WT, Topside=TS, Cargo Hold=CH, Other=O 6 RESPONSIBLE OFFICER S NAME AND TITLE (PRINTED) AND SIGNATURE Captain MARINER MASTER //207

2 CREW'S CURRENCY DECLARATION Page No.. Name of ship DEMO 7 Currency (amount and kind *) 2 Port where report is made.2 IMO Number.3 Call sign.4 Voyage Number X9XXX 99/207 3 Flag State of ship 8 Bearer-negotiable FLAG Currency amount Currency kind * Currency amount instruments ** (value and currency 4 No. 5 Family name, given names 6 Rank or rating in which valued) 9 Signature Currency kind * Currency amount Currency kind * Currency amount Currency kind * PORTOFARRIVAL/COUNTRY MASTER MARINER MASTER USD 25 TL 38 LEI 2 DECK OFFICER DECK OFFICER 358 TL 2 USD 6 EU 3 CHIEF ENGINEER CHIEF ENGINEER 260 USD 0.8 EU.5 TL 4 ENGINEER OFFICER ENGINEER OFFICER 5 ABLE SEAFARER ABLE SEAFARER DECK 6 ABLE SEAFARER ABLE SEAFARER DECK 7 CHIEF COOK COOK 0 and signature by master, authorized agent or officer //207 Captain MARINER MASTER * e.g. USD, Euro, GBP, TL, UAH, RUB ** e.g. checks, travel checks, bonds

3 IMO CREW LIST Convention on Facilitation of International Maritime Traffic Page No. X Arrival Departure. Name of ship DEMO 2 Port of arrival 3 of arrival.2 IMO Number PORTOFARRIVAL/COUNTRY 0/0/207.3 Call sign X9XXX.4 Voyage Number 99/207 4 Flag State of ship 5 Last port of call Nature and FLAG 6 No. 7 Family name, given names 8 Rank or rating 9 Nationality 0 and place of birth MASTER MARINER ENGINEER OFFICER ABLE SEAFARER ABLE SEAFARER 7 CHIEF COOK MASTER ENGINEER OFFICER ABLE SEAFARER DECK ABLE SEAFARER DECK COOK LASTPORT/COUNTRY DECK OFFICER DECK OFFICER 8/0/996 BIRTHPLACE CHIEF ENGINEER CHIEF ENGINEER 5/04/968 BIRTHPLACE 3/07/970 BIRTHPLACE 0/0/976 29/07/984 6/2/973 22/0/985 BIRTHPLACE BIRTHPLACE BIRTHPLACE BIRTHPLACE number of identity document S S U S U S U34938 S BB03930 GE0098 AB824 GE U S (Seaman Passport) (Seaman Book) IMO FAL Form 5 2 and signature by master, authorized agent or officer //207 Captain MARINER MASTER

STANDARD DATA SET OF SECURITY-RELATED PRE-ARRIVAL INFORMATION In compliance with SOLAS Chapter XI-2, Regulation 9.2..3 Particulars of the ship and contact details. IMO Number 9999999.

4 STANDARD DATA SET OF SECURITY-RELATED PRE-ARRIVAL INFORMATION In compliance with SOLAS Chapter XI-2, Regulation Particulars of the ship and contact details. IMO Number Name of ship DEMO.3 Port of registry PORTOFREGISTRY.4 Flag State FLAG.5 Type of ship GENERAL CARGO.6 Call Sign X9XXX.7 Inmarsat call numbers (if available) Gross tonnage Name of Company.0 IMO Company identification number Name and 24-hour contact details of the company security officer (or designated duty officer) 2 Port and port facility information 2. Port of arrival and port facility where the ship is to berth, if known 2.2 Expected date and time of arrival of the ship in port 2.3 Primary purpose of call 3 Information required by SOLAS regulation XI-2/ The ship is provided with a valid: 3.. The certificate indicated in 3. has been issued by MANAGEMENT COMPANY Capt. MERT KOSEOGLU Name - International Ship Security Certificate - Interim International Ship Security Certificate 24-hour contact telephone and which expires on 6/0/ If the ship is not provided with a valid International Ship Security Certificate or a valid Interim International Ship Security Certificate, explain why Does the ship have an approved ship security plan on board? YES PORTOFARRIVAL/COUNTRY 3.2 Current security level: MARSEC Level 3.2. Location of the ship at the time the report is made N W 3.3 List the last ten calls, in chronological order with the most recent call first, at port facilities at which the ship conducted ship/port interface together with the security level at which the ship operated: (Port of call No. 0 is the last one before the port at which entry is being sought.) 28/09/ LT WP AGW LOADING No. From To Port, country Port facility UNLOCode Security level 0 7/0/207 8/0/207 SAMSUN, TURKEY 003 TRSSX 9 09/0/207 0/0/207 YEYSK, RUSSIA 003 RUYEY 8 22/09/207 02/0/207 KARASU, TURKEY 0004 TRKSP 7 7/09/207 8/09/207 YEYSK, RUSSIA 003 RUYEY 6 0/09/207 3/09/207 SAMSUN, TURKEY 003 TRSSX 5 27/08/207 28/08/207 YEYSK, RUSSIA 003 RUYEY 4 22/08/207 23/08/207 SAMSUN, TURKEY 003 TRSSX 3 7/08/207 8/08/207 YEYSK, RUSSIA 0023 RUYEY 2 07/08/207 08/08/207 VOLOS, GREECE 00 GRVOL 3/07/207 02/08/207 MARSAXLOKK, MALTA 0005 MTMAR YES INTERNATIONAL SHIP CLASSIFICATION 3.3. Did the ship, during the period specified in 3.3, take any special or additional security measures, beyond those specified in the approved ship security plan? If the answer to 3.3. is YES, for each of such occasions please indicate the special or additional security measures which were taken by the ship: No. From To Special or additional security measures 2 3 Page /2

5 Page 2/2 3.4 List the ship-to-ship activities, in chronological order with the most recent ship-to-ship activity first, which have been carried out during the period specified in 3.3: No. From To Location or latitude and longitude Not applicable X Ship-to-ship activity Have the ship security procedures, specified in the approved ship security plan, been maintained during each of the ship-to-ship activities specified in 3.4? If the answer to 3.4. is, identify the ship-to-ship activities for which the ship security procedures were not maintained and indicate, for each, the security measures which were applied in lieu: No. From 2 3 To Security measures applied Ship-to-ship activity In compliance with SOLAS Chapter XI-2, Regulation Provide a general description of cargo aboard the ship: CARGO ABOARD 3.5. Is the ship carrying any dangerous substances (i.e., those covered by the International Maritime Dangerous Goods Code) as cargo? If the answer to 3.5. is YES, provide details or attach a copy of the Dangerous Goods Manifest (IMO FAL Form 7) 3.6 A copy of the ship's Crew List (IMO FAL Form 5) is attached YES 3.7 A copy of the ship's Passenger List (IMO FAL Form 6) is attached 4 Other security-related information 4. Is there any security-related matter you wish to report? 4.. If the answer to 4. is YES, provide details (e.g., carriage of stowaways or persons rescued at sea). 5 Agent of the ship at the intended port of arrival 5. Name and contact details (telephone number) of the agent of the ship at the intended port of arrival: 6 Identification of the person providing the information 6. Name: 6.2 Title or position: 6.3 Signature: Captain MARINER MASTER This report is dated at N W on //207 5:52LT

6 SHIP'S MEDICINE LIST. Name of ship DEMO 2 Port where report is made 3.2 IMO Number PORTOFARRIVAL/COUNTRY 0/0/207.3 Call sign X9XXX.4 Type of ship GENERAL CARGO 4 Flag State of ship 5 of last check FLAG 0/06/206 Page No. In compliance with International Medical Guide for Ships (IMGS), 3rd Edition 2007, World Health Organization (WHO) MEDI Form 6 Number of persons onboard 7 WHO Category of ship 8 Location on board 7 9 Name of article 0 Quantity 9 Name of article 0 Quantity Acetylsalicylic acid Aciclovir Adrenaline Amethocaine (tetracaine hydrochloride) Amoxicillin +clavulanate acid Artemether Artemether +Lumefantrine Atropine Azithromycin Ceftriaxone Cetirizine Charcoal, activated Ciprofloxacin Cloves, oil of Dexamethasone Diazepam Docusate with senna Doxycyline Ethanol (Gel, hand cleanser) Ethanol (Liquid) Fluorescein Frusemide Glucagon Haloperidol Hydrocrotisone Ibuprofen DEET 20-35% formulation or Picaridin Isosorbide dinitrate Lignocaine Loperamide Mebendazole Metroprolol Metronidazole Miconazole Midazolam Misoprostol Category B and signature by master, authorized agent or officer //207 MASTER'S CABIN 60 TABLET Morphine (Ampoule) 50 TABLET Morphine (Liquid/Tablet) 0 AMP Naloxone 40 TABLET 30 TABLET 20 TABLET TUBE Omeprazole 5 TABLET Ondanestron 0 TUBE Oral rehydration salts sachets of powde Oxymetazoline 0 PCS Paracetamol 6 TABLET Permethrin (%) Permethrin (%5) PCS Salbutamol 5 PCS Tramadol 5 PCS Water for injection PCS Zidovudine +lamivudine 58 TABLET Zinc oxide Povidone iodine (Ointment) Povidone iodine (Liquid) Prednisone 2 PCS Petroleum jelly (Vaseline) Volume spacer for salbutamol inhaler Sodium chloride (l ) Sodium chloride (0 ml) Tetracycline Tetanus Immunoglobulin (Ampoule) Tetanus toxoid vaccination (Ampoule) Vitamin K (Phytomenadione) 40 TABLET 0 TABLET 9 TABLET TUBE 2 TUBE 25 TABLET 0 PCS TUBE 56 tab 9 tab Captain MARINER MASTER - Controlled Drug - Not required for ship's category 2 PCS 2 BOTTLE 40 TABLET PCS TUBE PCS 0 PCS 2 TUBE 2 PCS 5 AMP 3 PCS 8 TABLET 5 TUBE 2 TABLET Remarks

7 OWNER COMPANY Owner Address R Port : PORTOFARRIVAL/COUNTRY : 7 June 206 Notice of Readiness Gentlemen, I, Capt. MARINER MASTER the of M/V DEMO, arrived at the port of PORTOFARRIVAL/COUNTRY on 7 June 206 at 7:00 hours local time, hereby declare that the above vessel under my command is ready in all respects to discharge a complete cargo of XXXXmtons of Cargo XXXX, in accordance with all terms, conditions and exceptions to the relevant charter party. You are therefore kindly requested to commence discharging immediately commending the above to your prompt attention. Yours very truly. Signed Capt. MARINER MASTER The above Notice of Readiness was tendered at hours on. Accepted at hours on. For the Charterers Shippers/Receivers/Agent * Signed * Delete as appropriate.

8 STANDARD FORMAT OF THE ADVANCE TIFICATION FORM FOR WASTE DELIVERY TO PORT RECEPTION FACILITIES Notification of the Delivery of Waste to : PORTOFARRIVAL/COUNTRY (enter name of port or terminal) The master of a ship should forward the information below to the designated authority at least 24 hours in advance of arrival or upon departure of the previous port if the voyage is less than 24 hours This form shall be retained on board the vessel along with the appropriate Oil RB, Cargo RB or Garbage RB DELIVERY FROM SHIPS (ANF). SHIP PARTICULARS. Name of Ship DEMO.5 Owner or Operator MANAGEMENT COMPANY.2 IMO Number Distinctive number or letters X9XXX.3 Gross tonnage Flag State FLAG.4 Type of ship Oil tanker Chemical tanker Bulk Carrier Container Other cargo ship Passenger ship Ro-ro Other (specify) 2. PORT AND VOYAGE PARTICULARS 2. Location/Terminal name and POC PRESENTPORT 2.6 Last Port where waste was delivered RUNVS 2.2 Arrival and Time 0/0/ of Last Delivery 06/06/ Departure and Time 2.8 Next Port of Delivery (if known) NEXTPORT/COUNTRY 2.4 Last Port and Country LASTPORT/COUNTRY 2.9 Person submitting this form is (if other than the master) 2.5 Next Port and Country (if known) NEXTPORT/COUNTRY Captain MARINER MASTER In compliance with IMO MEPC./Circ.67/Rev. 3. TYPE AND AMOUNT OF WASTE FOR DISCHARGE TO FACILITY MARPOL Annex I - Oil Quantity (m3) MARPOL Annex V - Garbage Quantity (m3) Oily bilge water NIL A. Plastic 0.20 Oily residues (sludge) NIL B. Food wastes 0.20 Oily tank washings C. Domestic wastes (e.g Dirty ballast water paper products, rags, glass, Scale and sludge from tank cleaning metal, bottles, crockery, etc.) Other (please specify) D. Cooking oil 0.00 MARPOL Annex II - NLS Quantity (m3) 5 E. Incinerator ashes Category X substance F. Operational wastes Category X substance G. Cargo residues 6 Category X substance H. Animal carcass(es) OS - other substances I. Fishing gear MARPOL Annex IV - Sewage Quantity (m3) MARPOL Annex VI Air Quantity (m3) Sewage NIL Ozone-depleting substances NIL and equipment containing such substances Exhaust gas-cleaning NIL : //207 Name and Position: Captain MARINER MASTER Time: 5:52LT Signature: 5 6 Indicate the proper shipping name of the NLS involved. Indicate the proper shipping name of the dry cargo. Page /2

9 Page 2/2 Name of Ship DEMO IMO Number Please state below the approximate amount of waste and residues remaining on board and the percentage of maximum storage capacity. If delivering all waste on board at this port please strike through this table and tick the box below. If delivering some or no waste, please complete all columns. I confirm that I am delivering all the waste held on board this vessel (as shown on page ) at this port Type MARPOL Annex I - Oil Oily bilge water Oily residues (sludge) Oily tank washings Dirty ballast water Scale and sludge from tank cleaning Other (please specify) MARPOL Annex II - NLS 7 Category X substance Category Y substance Category Z substance OS - other substances MARPOL Annex IV - Sewage Sewage MARPOL Annex V - Garbage A. Plastic B. Food wastes C. Domestic wastes (e.g. paper products, rags, glass, metal, bottles, crockery, etc.) D. Cooking oil E. Incinerator ashes F. Operational wastes G. Cargo residues 8 H. Animal carcass(es) I. Fishing gear Maximum dedicated storage capacity m Amount of waste retained on board m Port at which remaining waste will be delivered (if known) Next Port Next Port Next Port Estimate amount of waste to be generated between notification and next port of call m Next Port : //207 Name and Position: Captain MARINER MASTER Time: 5:52LT Signature: 7 8 Indicate the proper shipping name of the NLS involved. Indicate the proper shipping name of the dry cargo.

Harlingen Port Authority

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