Pre-Arrival Form

* - denotes a required field.

*Vessel: *IMO Number:
*Registered
Flag State:		 *Ship's Last
UK Visit:
(dd/mm/yyyy)

Dangerous Goods Carried (Over 10kg) and UN Class Number:

Does the Ship Have a Valid International Ship Security Certificate (ISSC)?

If 'no', please give reasons:
At What Security Level is the Ship Operating?

Recent Ports-of-Call

What Were the Last 10 Ports-Of-Call and What Was the Ship's Security Levels During Those Ship / Port Interfaces? (start with 1 as the most recent port visited).

Name of Port
and Country		 Date Port Visited
dd/mm/yyyy		 Security
Level
1
2
3
4
5
6
7
8
9
10
Have Any Special Security Arrangements Been Taken by the Ship During
the Ship / Port Interface at the Last 10 Ports-Of-Call?

If 'yes', please provide details including locations and dates:
Have Appropriate Procedures Been Followed During Any Ship / Ship Activity During the Last 10 Ports-Of-Call,
e.g. Were These Interactions Governed by the Security Requirements in the SSP?

If 'no', please provide details including locations and dates:
Any Other Practical Security Related Information, e.g. Have You
Witnessed Any Suspicious Activity During the Voyage?

If 'yes', please provide details including locations and dates:

* - denotes a required field.

*Agent's Name / Company:
*Date:
(dd/mm/yyyy)