Ship Security Declaration
Name of Ship
IMO Number
Flag State
Port of Arrival
Port Facility
Date of Arrival
Date of Departure
This declaration is valid from
to
Security Levels:
Ship Security Level
Port Facility Security Level
Details of the Security Measures Agreed Between Ship and Port Facility:
Additional Information
Name and Title of Ship's Master or Ship Security Officer
Date:
Name and Title of Port Facility Security Officer
Date: