Date:
To:
Authority:
Subject: Ballast Water Discharge Notification
Dear Sir/Madam,
This letter is to notify you of the discharge of ballast water as required under relevant regulations and procedures. The details of the vessel and ballast operations are as follows:
Vessel Name
IMO Number
Call Sign
Flag
Port of Discharge
Date and Time of Discharge
Latitude / Longitude
Total Ballast Water Discharged (m³)
Ballast Water Source Location
Ballast Water Management Method
Should you require any further information or clarification, please do not hesitate to contact us.
Sincerely,

Name:
Rank/Position:
Company/Ship:
Contact Details: