Ballast Water Reporting Form for Port State Control
Ship Information
Vessel Name
IMO Number
Flag
Owner
Voyage Number
Port of Arrival
Date of Arrival
Ballast Water Management
Management Method
Exchange
Treatment
None
Type of System
Date of Last Operation
Ballast Water Operations
Source Port
Source Date
Volume Taken On Board (m³)
Discharge Port
Discharge Date
Volume Discharged (m³)
Certification & Additional Information
Ballast Water Management Certificate Authority
Remarks
Person Completing Form
Name
Rank
Date
Signature