| Vessel Name | IMO/MMSI Number | ||
| Flag | Call Sign | ||
| Master’s Name | Shipping Agent | ||
| Arrival Date & Time | Departure Date & Time | ||
| Last Port of Call | Next Port of Call | ||
| No. of Passengers on Board | No. of Crew on Board | ||
| Purpose of Call | |||
| Health Clearance | |
| Immigration Clearance | |
| Customs Clearance | |
| Quarantine Clearance |
| Remarks | |||
| Master’s Signature | Date |
| Port Authority Approval | Date |