Marine Waste Disposal Declaration Form
Vessel Name
IMO Number
Flag State
Operator/Owner
Date of Arrival
Date of Departure
Port Name
Disposal Agent
Type of Waste
Oily Waste (Sludge/Bilge)
Garbage (Plastic, Food, etc.)
Sewage
Ballast Water
Hazardous Waste
Other
Quantity (m³/tons)
Date of Disposal
Remarks
Declarant Name
Signature
Date