Ship Security Pre-Arrival Information Form
1. Ship Details
Ship Name
IMO Number
Flag State
Call Sign
Gross Tonnage
Company Name
2. Port & Arrival Details
Port of Arrival
Arrival Date
Arrival Time
3. Security Levels
Security Level at this Port
Level 1
Level 2
Level 3
Security Level during last 10 port calls
Level 1
Level 2
Level 3
4. Last 10 Ports of Call
List Ports and Dates
5. Ship Security Plan (SSP)
Does the ship have a valid SSP?
Yes
No
Issued by (Administration/Authority)
6. Security Measures & Activities
Has the ship taken any special or additional security measures?
Yes
No
If yes, provide details
7. Security Incidents
Have there been any security incidents during the last 10 port calls?
Yes
No
If yes, provide details
8. Declaration
Name of Ship Security Officer (SSO)
Date
Signature