Ship/Port Interface Security Agreement Form
1. Ship Information
Ship Name
IMO Number
Company
2. Port Facility Information
Port Facility Name
Port Facility ID
Location
3. Security Levels
Security Level (Ship)
Level 1
Level 2
Level 3
Security Level (Port Facility)
Level 1
Level 2
Level 3
4. Agreed Security Measures
Description of Agreed Security Measures
5. Point of Contact & Communication
Ship
Port Facility
Name
Title/Rank
Phone
Email
6. Date & Signatures
Date
Name
Signature
Ship Security Officer
Port Facility Security Officer