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ship pre-arrival information pro-forma - The Bristol Port Company

By Kristen Spencer,2014-02-07 16:38
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SHIP PRE-ARRIVAL INFORMATION PRO-FORMA

    1 Name of Ship

    2 IMO Number

    3 Registered Flag State

    4 Date of ship’s last visit to UK

    5 Dangerous Goods carried (over 10 kg) and UN Class No.

    6 Does the ship have a valid International Ship YES NO - If not, please detail why? Security Certificate (ISSC)? Does it have an approved SSP? If this is the ship’s first visit to this Port, please provide a copy of the ISSC.

7 What Security Level is the ship operating at? 1 2 3

    8 What were the last 10 ports of call and what Name of Port Date Port Security

     was the Security Levels of the ship during & Country Visited Level

     those ship/port interfaces? 1 SL =

    Start with No. 1 as the most recent port visited. 2 SL =

    3 SL =

    4 SL =

    5 SL =

    6 SL =

    7 SL =

    8 SL =

    9 SL =

    10 SL =

9 Have any special security arrangements been YES - Please detail including location & date NO taken by the ship during ship/port interface at the last 10 ports of call?

    10 Have appropriate security procedures been NO - Please detail including location & date YES followed during any ship / ship activity during the last 10 ports of call, for example have these interactions been governed by the

    security requirements in the SSP?

    11 Any other practical security related information, YES - Please detail including location & date NO for example have you witnessed any suspicious activity during the voyage?

Form Completed By (Block Capitals): Organisation:

    Date of Completion:

For Port Use Name or Number of Allocated Berth

    Agents Name / Company ……………………………………………………………

    Date of completion ……………………………………………………………………

    Checked by BPC ……………………………….. Date & Time ……………………

SHIP PRE-ARRIVAL INFORMATION PRO-FORMA

List of dangerous goods

The following list refers to United Nations classifications.

Class 1, Division 1.1 Explosives

    Class 1, Division 1.2 Explosives

    Class 1, Division 1.3 Compatibility group C explosives

    Class 1, Division 1.5 Explosives

    Class 2.1 Flammable gases in bulk

    Class 2.3 Toxic gases (excluding aerosols)

    Class 3 Flammable liquids in bulk of packing groups I and II Class 3 and Class 4.1 Desensitised explosives

    Class 4.2 Goods of packing group I in bulk

    Class 4.3 Goods of packing group I in bulk

    Class 5.1 Oxidising liquids in bulk of packing group I

    Perchlorates, ammonium nitrate and ammonium nitrate Class 5.1 fertilisers, in bulk

    Class 6.1 Toxic substances of packing group I Class 6.2 Infectious substances of Category A

    Radioactive material in quantities greater than 3000 A 1

    (special form) or 3000 A, as applicable, in Type B or Class 7 2

    Type C packages

    Class 8 Corrosive substances of packing group I in bulk

SHIP PRE-ARRIVAL INFORMATION PRO-FORMA

    INTERNATIONAL SHIP and PORT FACILITY SECURITY

    AGENTS NOTIFICATION TO THE PORT FACILITY SECURITY

    OFFICER

Send completed form by email to: isps.arrival@bristolport.co.uk

    or by fax to Port of Bristol Police Fax: 0117 9380 205

    Name of Vessel: Date of Arrival:

    Tele: email: Agents details

     Name:

     Fax:

Ship’s Security Officer: Contact details:

Attach details to include: names of Company/Organisation;

    visitors names; vehicle registration numbers; expected

    time/date of arrival

    Crew list: Y/N Format of Crew identity Crew changes: Y/N card used by ships crew Detail:

    (e.g. Discharge book etc): Names/Rank

    copy

Passengers: Y/N

    Detail:

    Names

    Address

    Ship’s stores: Y/N Bunkers expected: Visitors expected: Y/N

     Y/N Detail:

    Detail: Detail: Names

    Driver Name Driver Name Company Name

    Company Name Company Name Company Address

    Company address Company address Vehicle registration (if Vehicle registration Vehicle registration required)

    List of Stores

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