Port Agent Stowaway Declaration Sheet
Vessel & Voyage Details
| Vessel Name |
|
IMO Number |
|
| Flag |
|
Port of Registry |
|
| Port of Arrival |
|
ETA |
|
| Port of Departure |
|
ETD |
|
| Agent Name |
|
Stowaway Information
| Full Name |
Nationality |
Date of Birth |
Gender |
Language Spoken |
|
|
|
|
|
| Date and Place Found |
|
| Location on Board |
|
| Details of Discovery |
|
| Personal Belongings |
|
| Physical Condition |
|
| Actions Taken |
|
Crew/Witness Statements
| Name of Crew/Witness |
Rank/Position |
Statement |
|
|
|
Declaration
I hereby declare that the above details are true and correct to the best of my knowledge.
Date:
Master's Name & Signature
Date:
Port Agent's Name & Signature