Ship’s Stores Declaration Form
Name of Ship
IMO Number
Flag
Call Sign
Port of Arrival
Date of Arrival
Name of Master
Ship’s Agent
Last Port of Call
Next Port of Call
Nationality of Crew
List of Ship’s Stores
No.
Description of Stores
Quantity
Unit
Remarks
1
2
3
4
5
Declaration
I declare that the information above is true and correct.
Name & Signature of Master
Date