P R A V I L N I K O NAČINU NAJAVE DOLASKA BRODA U LUKU I ODLASKA BRODA IZ LUKE

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914. Na osnovu člana 28 stav 8 i člana 30 stav 3 Zakona o sigurnosti pomorske plovidbe ( Službeni list CG, br. 62/13 i 47/15), Ministarstvo saobraćaja i pomorstva donijelo je P R A V I L N I K O NAČINU NAJAVE DOLASKA BRODA U LUKU I ODLASKA BRODA IZ LUKE Predmet Član 1 Ovim pravilnikom propisuje se način najave dolaska broda u luku i odlaska broda iz luke i obrasci odobrenja za slobodan saobraćaj i isplovljenje i obrasci isprava koje dostavlja brod koji namjerava da uplovi ili isplovi iz luke. Izuzeće od primjene Član 2 Ovaj pravilnik ne primjenjuje se na plovne objekte koje koriste organi državne uprave i koji služe u neprivredne svrhe i ratne brodove. Najava dolaska broda Član 3 Brod koji namjerava da uplovi u luku najavljuje dolazak najkasnije 24 sata prije dolaska u luku. Najava iz stava 1 ovog člana vrši se elektronskim putem. Prilikom najave iz stava 1 ovog člana dostavlja se: 1) opšta izjava data na obrascu 1 koji je sastavni dio ovog pravilnika; 2) zdravstvena izjava na obrascu 2 koji je sastavni dio ovog pravilnika; 3) spisak posade na obrascu 3 koji je sastavni dio ovog pravilnika; 4) spisak putnika na obrascu 4 koji je sastavni dio ovog pravilnika; 5) izjava o teretu na obrascu 5 koji je sastavni dio ovog pravilnika; 6) izjava o opasnom teretu na obrascu 6 koji je sastavni dio ovog pravilnika; 7) izjava o brodskim zalihama na obrascu 7 koji je sastavni dio ovog pravilnika; 8) izjava o ličnim stvarima članova posade na obrascu 8 koji je sastavni dio ovog pravilnika. Na osnovu prijave dolaska broda u luku izdaje se odobrenje dato na obrascu 9 koji je sastavni dio ovog pravilnika. Najava odlaska broda Član 4 Prilikom odlaska iz luke, brod najavljuje odlazak elektronskim putem najkasnije dva sat prije odlaska i preda spisak posade i putnika, samo onih lica koja su se ukrcala, odnosno iskrcala dok se brod nalazio u luci, kao i dokumentaciju iz člana 3 ovog pravilnika. Na osnovu prijave odlaska broda izdaje se dozvola za odlazak broda data na obrascu 10 koji je sastavni dio ovog pravilnika.

Stupanje na snagu Član 5 Ovaj pravilnik stupa na snagu osmog dana od dana objavljivanja u,,službenom listu Crne Gore", a primjenjivaće se od 1. januara 2017. godine. Broj: 342-164/2016-3 Podgorica, 6. jula 2016. godine Ministar, Ivan Brajović, s.r.

OPŠTA IZJAVA (Obrazac FAL 1) GENERAL DECLARATION ( IMO FAL Form 1) Dolazak Arrival 1.1 Ime i vrsta broda / Name and type of ship 1.2 IMO broj / IMO number Odlazak Departure Obrazac 1 1.3 Pozivni znak / Call sign 1.4 Broj putovanja / Voyage number 2. Luka dolaska/odlaska / Port of arrival/departure 3. Datum i vrijeme dolaska/odlaska Date and time of arrival/departure 4. Država zastava broda Flag State of ship 5. Ime kapetana broda Name of master 6. Zadnja luka / Sledeća luka Last port of call/next port of call 7. Podaci o upisu broda u registar (Luka, datum i broj) Certificate of registry (Port; date; number) 8. Naziv agenta i njegovi kontakti Name and contact details of ship s agent 9. Bruto tona Gross tonnage 10. Neto tona Net tonnage 11. Pozicija broda u luci (vez ili sidrište) Position of the ship in the port (berth or station) 12. Osnovne informacije o putovanju (prethodna i sledeća luka; navesti gdje će si iskrcati preostali teret) Brief particulars of voyage (previous and subsequent ports of call; underline where remaining cargo will be discharged) 13. Kratak opis tereta Brief description of the cargo 14. Broj posade Number of crew 15. Broj putnika Number of passengers 16. Primjedbe Remarks Dokumenti u prilogu (navesti broj kopija) Attached documents (indicate number of copies) 17. Izjava o teretu Cargo Declaration 18. Izjava o brodskim zalihama Ship s Stores Declaration 19. Popis posade Crew List 22. Izjava o ličnim stvarima posade (samo prilikom uplovljenja) Crew s Effects Declaration (only on arrival) 20. Popis putnika Passenger List 23. Pomorska zdravstvena izjava (samo prilikom uplovljenja) Maritime Declaration of Health (only on arrival) 21. Potrebe broda za predaju otpada i ostataka tereta u prihvatnim postrojenjima The ship s requirements in terms of waste and residue reception facilities 24. Datum i potpis kapetana, ovlašćenog agenta ili oficira Date and signature by master, authorized agent or officer Za službenu upotrebu / For official use

Obrazac 2 Zdrastvena izjava Maritime Declaration of Health Popunjavaju zapovjednici brodova koji dolaze iz stranih luka i dostavljaju je nadležnim vlastima To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports. Podnijeta u luci Submitted at the port of Ime broda ili plovila unutrašnje plovidbe Name of Ship or inland navigation vessel Dolazi iz (Posljednja luka)* Arriving from (Last port) * Nacionalna pripadnost/zastava broda Nationality / Flag of vessel Međunarodna bruto tonaža (BT) International Gross Tonnage (GT) Datum Date IMO broj IMO Number Plovi za (Sljedeća luka) Sailing to (Next port) Ime Zapovjednika Master's Name Međunarodna neto tonaža NT International Net Tonnage (NT) Da li je brod / plovilo unutrašnje plovidbe posjetio pogođeno područje identifikovano od strane Svjetske Zdrastvene Organizacije? Has ship / inland navigation vessel visited an affected area identified by World Health Organization? DA / NE YES / NO Luka i datum posjete (pogođenog područja) Port and date of visit (affected area) Broj članova posade ukrcanih na brod** Number of crew members on board** Broj putnika ukrcanih na brod** Number of passenger on board** Zdravstvena Pitanja Health Questions 1. Da li je bilo koje lice umrlo na brodu tokom putovanja drugačije nego kao rezultat nezgode? Has any person died on board during the voyage otherwise than as a result of an accident? Ako je DA, navedite detalje u priloženoj tabeli. Ukupan broj smrti... If YES, state particulars in attached schedule. Total number of deaths... 2. Da li postoji na brodu ili je postojao na brodu tokom putovanja bilo koji slučaj bolesti za koju sumnjate da je zarazne prirode? Is there on board or has there been during the international voyage any case of disease which you suspect to be of an infectious nature? 3. Da li je ukupan broj bolesnih lica tokom putovanja bio veći od normalnog / očekivanog? Koliko bolesnih lica? Has the total number of ill persons during the voyage been greater than normal / expected? How many ill persons? 4. Da li se na brodu sada nalazi bilo koje bolesno lice? Ako je DA, navedite detalje u priloženoj tabeli. Is there any sick person on board now? If YES, state particulars in attached schedule. 5. Da li je konsultovan ljekar? Ako je DA, navedite detalje o pruženom medicinskom tretmanu ili savjetu u priloženoj tabeli. Was a medical practitioner consulted? If YES, state particulars of medical treatment or advice provided in attached schedule. 6. Da li ste svjesni bilo kojeg stanja na brodu koje može dovesti do infekcije ili širenja bolesti? Are you aware of any condition on board which may lead to infection or the spread of disease? 7. Da li je bilo koja sanitarna mjera (npr. karantin, izolacija, dezinfekcija ili dekontaminacija) bila primijenjena na brodu? Ako je DA, specifikujte tip, mjesto i datum. Has any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board? If YES, specify type, place and date. 8. Da li su nađeni bilo koji slijepi putnici na brodu? Ako je DA, gdje su se ukrcali na brod (ako je poznato)? Have any stowaways been found on board? If YES, where did they join the ship (if known)? DA YES NE NO 9. Da li postoji bolesna životinja ili ljubimac na brodu? Is there a sick animal or pet on board? Napomena: U odsustvu ljekara, Zapovjednik treba cijeniti sljedeće simptome kao osnove za sumnju u postojanje bolesti zarazne prirode: Note: In the absence of a surgeon, the Master should regard the following symptoms as grounds for suspecting the existence of disease of an infectious nature: a) groznica, koja traje nekoliko dana ili koja je praćena malaksalošću, smanjena svijest, žljezdani otok, žutica, kašalj ili otežano disanje, neuobičajeno krvarenje ili paraliza.

a) fever, persisting for several days or accompanied by prostration, decreased consciousness, glandular swelling, jaundice, cough or shortness of breath, unusual bleeding, or paralysis b) sa ili bez groznice: bilo koji akutni osip ili probijanja na koži, teško povraćanje (drugo nego morska bolest); teška dijareja, ili povratni grčevi. b) with or without fever: any acute skin rash or eruption, severe vomiting (other than sea sickness); severe diarrhoea, or recurrent convulsions Važeći Sertifikat oslobađanja od kontrole/sertifikat kontrole je na brodu? Valid Sanitation Control Exemption/Control Certificate carried on board? DA YES Datum/ Date izdat u:/issued at: NE NO Ponovni pregled se zahtjeva? Re-inspection required? važi do:/valid till: DA YES NE NO Posljednja analiza pitke vode / Datum: Last analysis of the drinking water / Date: Zdravstveno uvjerenje / Datum: Medical certificate / Date: izdata u: issued at: izdato u: issued at: Da li prevozite nadimljeni teret / kontejnere? Do you transport fumigated cargo / containers? DA YES NE NO *Nabrojite luke pristajanja od početka putovanja sa datumima odlaska, ili unutar zadnjih trideset dana, kojegod da je kraće: *List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter: Luka Port Datum odlaska Date of departure Luka Port Datum odlaska Date of departure **Po zahtijevu nadležne vlasti luke dolaska, nabrojati članove posade, putnike ili druga lica koja su se ukrcala na brod / plovilo unutrašnje plovidbe od kada je međunarodno putovanje počelo ili unutar zadnjih trideset dana, kojegod da je kraće, uključujući sve luke / zemlje koje su posjećene u ovom periodu (dodati dodatna imena u priloženu tabelu): **Upon request of competent authority at port of arrival, list crew members, passengers or other persons who have joined ship / inland navigation vessel since international voyage began or within past thirty days, whichever is shorter, including all ports / countries visited in this period (add additional names to the attached schedule): Ime Name Ukrcalo se u luci Joined at port Datum ukrcaja Date of joining Ovim izjavljujem da su detalji i odgovori na pitanja dati u ovoj Zdrastvenoj Izjavi (uključujući tabelu) istiniti i tačni po mojem najboljem znanju i uvjerenju. I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief. Zapovjednik/Master Potpis/Signature Brodski ljekar (ako se prevozi) Ship's Surgeon (if carried)/ Supotpisani/Countersigned Datum/Date Prilog Pomorskoj Zdrastvenoj Izjavi Attachment of Maritime Declaration of Health Ime /Name Pol/ Sex Državljanstvo/ Nationality Klasa ili položaj/ Class or rating/ Godine starosti/ Age Luka, datum ukrcaja na brod, plovilo/ Port, date joined ship / vessel Priroda bolesti/ Nature of illness Datum početka simptoma/ Date of onset of symptoms Prijavljeno medicinskom službeniku luke?/ Reported to a port medical officer? Dispozicija slučaja ***) Disposal of case ***) Ljekovi, medikamneti ili drugo lječenje dato pacijentu/ Drugs, medicines or other treatment given to patient Komentari Comments ***Stanje, (1) bilo da se lice oporavilo ili je još bolesno ili je umrlo, i (2) bilo da je lice koje je još uvijek ukrcano na brodu, bilo evakuisano (uključujući ime luke ili aerodrome), ili je sahranjeno u moru. ***State, (1) whether the person recovered is still ill or died; and (2) whether the person is still on board, was evacuated (including the name of the port or airport), or was buried at sea.

SPISAK POSADE (Obrazac IMO FAL 5) IMO CREW LIST (IMO FAL Form 5) Dolazak Arrival Odlazak Departure Broj strana Page Number Obrazac 3 1.1 Ime broda / Name of ship 1.2 IMO broj / IMO number 1.3 Pozivni znak / Call sign 1.4 Broj putovanja / Voyage number 2. Luka dolaska/odlaska / Port of arrival/departure 3. Datum dolaska/odlaska / Date of arrival/departure 4. Državna zastava broda / Flag State of ship 5. Zadnja luka / Last port of call 6. Br. No. 7. Prezime, ime Family name, given names 8. Čin ili pozicija Rank or rating 9. Nacionalnost Nationality 10. Datum i mjesto rodj. Date and place of birth 11. Vrsta i broj ličnog dokumenta Nature and number of identity document 12. Datum i potpis kapetana, ovlašćenog agenta ili oficira /Date and signature by master, authorized agent or officer

SPISAK PUTNIKA (Obrazac IMO FAL 6) IMO PASSENGER LIST (IMO FAL Form 6) Dolazak/ Arrival Odlazak/ Departure Obrazac 4 Broj strana / Page Number 1.1 Ime broda / Name of ship 1.2 IMO broj / IMO number 1.3 Pozivni znak / Call sign 1.4 Broj putovanja / Voyage number 2. Luke dolaska/odlaska /Port of arrival/departure 3. Datum dolaska/odlaska / Date of arrival/departure 4. Državna zastava broad/ Flag State of ship 5. Prezime, ime Family name, given names 6. Nacionalnost Nationality 7. Datum i mjesto rodj. Date and place of birth 8. Vrsta ličnog ili putničkog dokumenta Type of identity or travel document 9. Serijski broj ličnog ili putničkog dokumenta Serial number of identity or travel document 10. Luka ukrcaja Port of embarkation 11. Luka iskrcaja Port of disembarkation 12. Tranzitni putnik Transit passenger or not 13. Datum i potpis kapetana, autorizovanog agenta ili oficira / Date and signature by master, authorized agent or officer

Obrazac 5 IZJAVA O TERETU (Obrazac FAL 2) IMO CARGO DECLARATION (IMO FAL Form 2) Dolazak Arrival 1.1 Ime broda / Name of ship 1.2 IMO broj / IMO number Odlazak Departure Broj strana Page Number 1.3 Pozivni znak / Call sign 1.4 Broj putovanja / Voyage number 2. Luka izvještavanja / Port where report is made 3. Država zastava broda / Flag State of ship 4. Ime kapetana / Name of master 5. Luka ukrcaja/ Luka iskrcaja Port of loading/port of discharge Teretnica br. B/L No.* 6. Oznake i broj Marks and Numbers 7. Broj i vrsta pakovanja; opis robe ili ukoliko je moguće HS kod Number and kind of packages; description of goods, or, if available, the HS Code 8. Bruto težina Gross weight 9. Jedininica mjere Measurement 10. Datum i potpis kapetana, ovlašćenog agenta ili oficira Date and signature by master, authorized agent or officer * Broj transportnog dokumenta. Takođe navesti izvornu luku isporuke za robu koja se prevozi multimodalnim transportnim dokumentom ili preko teretnice. Transport document number. Also state original ports of shipment in respect to goods shipped on multimodal transport document or through bills of lading.

IZJAVA O OPASNOM TERETU (Kao što zahtjeva SOLAS 74, poglavlje VII, uredbe 4.5 i 7-2.2, MARPOL 73/78, Aneks III, uredbe 4.3 i poglavlje 5.4, član 5.4.3.1 IMDG koda) IMO DANGEROUS GOODS MANIFEST (IMO FAL Form 7) (As required by SOLAS 74, chapter VII, regulations 4.5 and 7-2.2, MARPOL 73/78, Annex III, regulation 4.3 and chapter 5.4, paragraph 5.4.3.1 of the IMDG Code Broj strana Page Number 1.1 Ime broda / Name of ship 1.2 IMO broj / IMO number 1.3 Pozivni znak / Call sign 1.4 Broj putovanja/ Voyage number 2. Državna zastava broda /Flag State of ship 3. Luka utovara / Port of loading 4. Luka istovara / Port of discharge 5. Rezervacija / Referentni broj Booking/ Reference Number 6. Oznake & brojevi Id brojevi kontejnera Reg. brojevi vozila Marks & Numbers Container Id. No(s). Vehicle Reg. No(s). 7. Broj i vrsta Paketa Number and kind of packages 8. Pravilan naziv isporuke Proper Shipping Name 9. Klasa Class 10. UN br./ UN No. 11. Grupa pakovanja Packing Group 12. Dodatni Rizici Subsidiary Risk(s) 13. Tačka paljenja u u C Flashpoint (in ºC.c.c.) 14. Zagađenje Marine Pollutant 15. Masa (kg) Bruto/Neto Mass ( kg) Gross/Net 16. EmS EmS 17. Položaj skladišta na brodu Stowage position on board Dodatne informacije /Additional information 18.1 Ime kapetana / Name of master 19.1 Agent /Shipping Agent 18.2 Mjesto i datum / Place and date 19.2 Mjesto i datum / Place and date Potpis Kapetana / Signature of master Potpis Agenta / Signature of Agent

Obrazac 7 IZJAVA O BRODSKIM ZALIHAMA (Obrazac IMO FAL 3) IMO SHIP S STORES DECLARATION (IMO FAL Form 3) Dolazak Arrival Odlazak Departure Broj Strane Page Number 1.1 Ime broda /Name of ship 1.2 IMO broj / IMO number 1.3 Pozivni znak / Call sign 1.4 Broj putovanja / Voyage number 2. Luka dolaska/odlaska / Port of arrival/departure 3. Datum dolaska/odlaska / Date of arrival/departure 4. Dražavna zastava broda /Flag State of ship 5. Zadnja luka / Sljedeća luka Last port of call/next port of call 6. Broj osoba na brodu / Number of persons on board 7. Vrijeme ostanka / Period of stay 8. Ime artikla/ Name of article 9.Količina Quantity 10. Lokacija na brodu Location on board 11. Koristi se za / Official use 12. Datum i potpis kapetana, ovlašćenog agenta ili oficira / Date and signature by master, authorized agent or officer

IZJAVA O LIČNIM STVARIMA ČLANOVA POSADE (Obrazac IMO FAL 4) IMO CREW S EFFECTS DECLARATION (IMO FAL Form 4) Obrazac 8 Broj strana / Page Number 1.1 Ime broda /Name of ship 1.2 IMO broj / IMO number 1.3 Pozivni znak /Call sign 1.4 Broj putovanja /Voyage number 2. Državna zastava broda / Flag State of ship 3. Br. No. 4. Prezime, ime Family name, given names 5. Čin ili pozicija Rank or rating 6. Stvari koje me mogu biti oslobođene plaćanja carine ili su predmet zabrane ili restrikcija Effects ineligible for relief from customs duties and taxes or subject to prohibitions or restrictions * 7. Potpis Signature 8. Datum i potpis kapetana, ovlašćenog agenta ili oficira Date and signature by master, authorized agent or officer * primjer : vina, alkoholna pića, cigarete, duvan, idt / e.g., wines, spirits, cigarettes, tobacco, etc.

Obrazac 9 CRNA GORA MONTENEGRO MINISTARSTVO SAOBRAĆAJA I POMORSTVA MINISTRY OF TRANSPORT AND MARITIME AFFAIRS LUČKA KAPETANIJA: HARBOUR MASTER S OFFICE: Broj: No Mjesto, datum, sat : Place, date, hour Na osnovu člana 30 Zakona o sigurnosti pomorske plovidbe ( Službeni list CG broj 62/13), izdaje se: According to Art. 30 of Law on Maritime Safety ( Official gaz., No. 62/13) it is issued: ODOBRENJE ZA SLOBODAN SAOBRAĆAJ SA OBALOM FREE PRATIQUE Brodu To the vessel BT GT NT NT Zastave Flag Luke Upisa Port of Registry Pod zapovjedništvom Master Sledeća luka Next port Agent broda u luci Ship s agent Brodar Ship s owner MP Stamp ZAPOVJEDNIK MASTER/AGENT MP Stamp OVLAŠĆENO LICE AUTHORIZED PERSON

Obrazac 10 CRNA GORA MONTENEGRO MINISTARSTVO SAOBRAĆAJA I POMORSTVA MINISTRY OF TRANSPORT AND MARITIME AFFAIRS LUČKA KAPETANIJA: HARBOUR MASTER S OFFICE: Broj: No Mjesto, datum, sat : Place, date, hour Na osnovu člana 30 Zakona o sigurnosti pomorske plovidbe ( Službeni list CG broj 62/13), izdaje se: According to Art. 30 of Law on Maritime Safety ( Official gaz., No. 62/13) it is issued: ODOBRENJE ZA ODLAZAK BRODA PERMIT OF VESSEL S DEPARTURE Brodu To the vessel BT GT NT NT Zastave Flag Luke Upisa Port of Registry Pod zapovjedništvom Master Sledeća luka Next port Agent broda u luci Ship s agent Brodar Ship s owner Iz luke, unutrašnjih morskih voda i teritorijalnog mora Crne Gore From the port of, Inland Waters and Territorial Waters of Montenegro MP Stamp ZAPOVJEDNIK MASTER/AGENT MP Stamp OVLAŠĆENO LICE AUTHORIZED PERSON