International Ship and Port Facility Security (ISPS) Code
Declaration Form
Ship Information
Ship Name
IMO Number
Flag State
Call Sign
Gross Tonnage
Company Name
Port Facility Information
Port Facility Name
Location
UN/LOCODE
Declaration Details
Date of Arrival
Date of Departure
Security Level (1/2/3)
1
2
3
Description of Security Measures Taken
Details of Last 10 Ports/Facilities Visited
Responsible Person
Name
Title/Position
Signature
Date