Ballast Water Discharge Form

* - denotes a required field.

*Vessel: *Call Sign:
*Port of Registry: *IMO Number:

*In accordance with the information supplied by the accompanying Ballast Water Reporting form the following ballast water tanks are requested to be discharged within Scapa Flow:

I declare that the information submitted is correct, and that the appropriate pre-arrival minimum ballast water exchange criteria for Scapa flow has been adhered to.

* - denotes a required field.

*Master:
*Date:
(dd/mm/yyyy)