Ballast Water Reporting Form
Vessel Name
IMO Number
Voyage Number
Flag
Name of Master
Port of Arrival
Date of Arrival
Last Port of Call
Ballast Water Information
Tank Name/Number
Capacity (m³)
Ballast Water Source (Port & Country)
Date Loaded
Ballast Water Exchange Performed?
Date Exchanged
Location (Lat/Long)
Volume Exchanged (m³)
Ballast Water Discharge Port
Volume Discharged (m³)
Date Discharged
Ballast Water Treatment System Used
System Type
Remarks
Signature of Master or Officer in Charge
Date