Waste Notification Form

* - denotes a required field.

*Vessel: *Call Sign:
*Last Port: *IMO Number:
*Next Port: *ETA:
(dd/mm/yyyy)
*Flag State: *ETD:
(dd/mm/yyyy)

Last Port and Date When Waste Was Delivered Ashore?

Oily Waste Port: Date:
(dd/mm/yyyy)
Garbage Port: Date:
(dd/mm/yyyy)

What Are You Delivering?

of your waste into port facilities.

If you are delivering all of your waste, then please complete only the second column in the table below.

If you are delivering some or no waste, then please complete all columns.

Type Waste to be delivered (m³) Maximum dedicated storage capacity (m³) Amount of waste on board Port/Terminal at which remaining waste will be delivered Amount of waste to be generated between notification and next port (m³)
1. Waste Oils
Sludge
Bilge Water
Others (specify)
2. Garbage
Food Waste
Plastic
Other
3. Cargo Associated Waste* (specify)
4. Cargo Residues* (specify)

* - denotes a required field.

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