REQUIRED DOCUMENTS PRIOR TO ARRIVAL

Important Notice: All certificates must be in ".pdf " format.

* Ships' particulars
* Last Port Clearance
* Class Certificate
* Ship Register Certificate
* International Load Line Certificate
* International Tonnage Certificate
* Minimum Safe Manning Certificate
* Safety Equipment Certificate + Form E
* Safety Construction Certificate
* Safety Radio Certificate
* IOPP Cerrificate
* Sewage Pollution Certificate
* Safety Management Certificate
* International Ship Security Certificate
* Continuous Synopsis Record
* CLC Certificate
* CLC 92 Certificate (Only For Tankers Over 2000GRT)
* P&I Certificate
* Ship Sanitation Certificate
* Medical Certificate (if any)
* Bow Thruster Certificate (if any)
* 2 Officers' GMDSS Certificates
* All Officer and Engineer Endorstment
* All Persons Passport copy (first page)
* Bill(s) of Lading (for Mersin)
* Cargo Manifest(s) (for Mersin)
* Bill(s) of Lading (For transit cargo)
* Cargo Manifest(s) (For transit cargo)
* Stowage Cargo Plan
* Last Waste Delivery Receıpt
* Last 10 Ports of Call List
* Crew List (Please send in excel format if possible)
any person on board without seamanbook has to be placed
* Passenger List (if any)
on the passenger list
* Certificate List (form is attached)
* Ballast Water Reporting Form (form is attached)
* Waste Notification Form (form is attached)
*
Free pratique shall be granted on arrival in subject to the
*
procedures as follows;
*
* * "Last ports of call" should be attached to MHD.
* Maritime Health Declaration (form is attached) Form to be submitted directly from ship to Sanitary Office via
* e-mail "[email protected]". Please CC us.
*
* * Form has to be submitted earliest 1 day before arrival.
* Vessel's coming from Black Sea has to submit the form
* upon passing Bosphorus.
*

REQUIRED INFORMATIONS PRIOR TO ARRIVAL

Owners / Managers Info
* Owner's Details
Company Name MANESSA MARITIME
Company IMO number 5521189
Address
Phone / Fax
* Manager's Details
Company Name
Address
Phone / Fax
* DPA's details
Name of the DPA
Contact details
Ship's Particulars
* Number of the passengers
* Number of the crew
* Full Name of the Captain
* Estimated drafts on arrival FWD: 1.8 MID: 3.6 AFT: 4.2
* Estimated drafts on departure FWD: 6.60 MID: 6.10 AFT: 6.90
* Moulded draft in balast condition FWD: MID: AFT:
* Air draft
* Freeboard
* Trimming Angle (°)
* Number of the Main Engines
* Main Engine Power (KW)
* Rudder System AZIMUTH AZIPOD DOUBLE SINGLE

AZIMUTH AZIPOD PITCH CONTROL

* Propeller System
* If there is Dangerous Cargo on board? YES ✘ NO

If yes, have "MSDS" on board? YES ✘ NO

* Any Fault, Malfunction or Defect? YES ✘ NO

If yes, please explain
* If fitted with Bow thruster? YES ✘ NO
Capacity (KW) KW
Number of the Bow Thruster
Working with %100 efficiency YES NO

* If fitted with Stern thruster? YES NO

Capacity (KW) KW
Number of the Stern Thruster
Working with %100 efficiency YES ✘ NO

Port State Control (PSC)

* Last Mediterranean MOU port ?
* Last Mediterranean MOU date ?
* Was the vessel detained? YES ✘ NO

If yes, please explain the reason

P&I and other certificates
* Does the vessel have below certificates?
* "P&I" certificate? ✘ YES NO

Name of the "P&I" Club?

Policy Number
Expiry Date of the "P&I" certificate?
* "Sewage Pollution Prevention Certificate" ? YES NO

* "International Oil Pollution Prevention(IOPP)" ? YES NO

Expiry Date 08/11/2023

* "Bunker CLC" certificate ? ✘ YES NO

Expiry Date 31/01/2024

ISPS Details
* Ship's Security Level ✘ LEVEL 1 LEVEL 2 LEVEL 3

VTS Info
* VTS Area Entering Date & Time
* Current Latitude & Longtitude
Bunker Details
* Sulphur Percentage in Fuel on Arrival (%) %
* F.O. D.O. LUB OIL FW
Arrival Bunker's (estimated)
* 28000L 2500 L 15
* F.O. D.O. FW
Tank Capacities
* 140000 3000 40
Waste Disposal
* Type of the vessel
* Next Port of Call After MERSIN and ETA (if known)
* Next Port of Delivery (if known)
* Last Port Where Waste Was Delivered
* Date of Last Delivery
* Will the vessel deliver any waste to MERSIN? YES NO

Ballast Info
* Total Number of Ballast Tanks On Board 9
* Number of Tanks In Ballast
* Number of Tanks Exchanged
* Number of Tanks Not Exchanged
* Have "IMO Guide" On Board? YES ✘ NO

* Have "Ballast Water Manegment Plan" On Board? ✘ YES NO

* Responsible Officer's Full Name

* Responsible Officer's Rank
Incidents
* Any incident on board during the voyage YES ✘ NO

* If yes, type of the incident Please Select From the List >>>
* If yes, date & time of the incident
* If yes, place of the incident
* If yes, Latitude & Longtitude
* Any additional note for the incident
Other Details
* Master's / Vessel's Mobile Phone Number 00963966257047
* Average Speed 9
* Daily Consumption of D.O. / M.G.O. at port 6200 L
* Voyage Number 24
* ETA to Turkish Territorial Waters (Date & Time) 03/10/2023
* Last Port of Call & Departure Date ABU QIR 01/10/2023
* If original Bill(s) of Lading on board
* If there is any weapons on board NIL
* If has incinerator on board NIL

* Please Select From the List >>> Please Select From the List >>>
* 12 - FOULT 10 - Oil Tanker
* 11 - ENVIRONMENTAL POLLUTION 11 - Chemical Tanker
* 17 - OTHERS 12 - Bulk Carrier
* 15 - DENUNCIATION 13 - Container
* 13 - STOWAWAY 14 - Other Cargo Ship X
* 14 - ACCIDENT 15 - Passenger Ship
* 16 - INFRINGEMENT 16 - Ro-ro
* 14 - MEDICAL AID 17 - Other
 LİMAN BAŞKANLIĞI MAKAMI'NA,MERSIN
TO HARBOR MASTER,MERSIN

Name of the Vessel : M/V /MOHAMMED S

IMO Number7522203 :

DATE OF ISSUED
DATE OF EXPIRY
#1 CLASS CERTIFICATE : 6/8/2023 11/7/2023

#2 SHIP’S REGISTER CERTIFICATE : 7/24/2023

#3 INTERNATIONAL LOAD LINE CERTIFICATE : 6/8/2023 11/7/2023

#4 INTERNATIONAL TONNAGE CERTIFICATE : 7/25/2023

#5 MINIMUM SAFE MANNING CERTIFICATE : 7/24/2023 5/28/2024

#6 CARGO SHIP SAFETY EQUIPMENT CERTIFICATE : 6/8/2023 11/7/2023

#7 CARGO SHIP SAFETY CONSTRUCTION CERTIFICATE : 6/8/2023 11/7/2023

#8 CARGO SHIP SAFETY RADIO CERTIFICATE : 6/8/2023 11/7/2023

#9 INTERNATIONAL OIL POLLUTION PREVENTION CERTFICATE : 6/8/2023 11/7/2023

#10 SEWAGE POLLUTION PREVENTION CERTIFICATE : 6/8/2023 11/7/2023

#11 SAFETY MANAGEMENT CERTIFICATE : 6/8/2023 12/7/2023

#12 INTERNATIONAL SHIP SECURITY CERTIFICATE : 6/8/2023 12/7/2023

#13 CONTINUOUS SYNOPSIS RECORD (CSR) CERTIFICATE : 7/25/2023

#14 CIVIL LIABILITY FOR OIL POLLUTION DAMAGE, 1992 : 6/8/2023 1/31/2024

#15 CIVIL LIABILITY FOR BUNKER OIL POLLUTION DAMAGE, 2001 : 6/8/2023 1/31/2024

MASTER
 DENİZ SAĞLIK BİLDİRİMİ
MARITIME DECLARATION OF HEALTH
Yabancı limanlardan gelen gemilerin kaptanı tarafından doldurulup yetkili makamlara teslim edilecektir.
To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports.
limanında, tarihinde teslim edilmiştir.
submitted at the port of ALI AGA date /10/2023
Geminin ya da iç su gemisinin adı Kayıt / IMO Numarası
Name of ship or inland navigation vessel MOHANNED S Registration / IMO No 7522203
geldiği yer gideceği yer
arriving from ABU QIR sailing to MERSIN
(Tabiiyeti)/(Geminin Bayrağı) Gemi kaptanının adı
(Nationality)/(Flag of vessel) TANZANIA Master's name MALEK JUNDI
(Geminin) grostonu (İç su gemisinin) tonajı
Gross tonnage (ship) 3,307 Tonnage (Inland navigation vessel) 1579
Gemide geçerli bir sağlık kontrolünden Muafiyet / Sağlık Kontrol Sertifikası var mı?
Valid Sanitation Control Exemption / Control Certificate carried on board?
Evet Hayır Düzenlendiği yer Tarih
yes No Issued at ALI AGA Date 12/4/2023
Yeniden incelenmesi gerekiyor mu? Evet Hayır
Re-inspection required yes No
Gemi / Deniz aracı Dünya Sağlık Örgütü tarafından tesbit edilen etkilenmiş bir bölgeye uğradı mı?
Has ship/vessel visited an affected area identified by the Word Health Organization?
Evet Hayır Uğrak limanı ve tarih
yes No port and date of visit
Yolculuğun başlangıcından itibaren veya son otuz gün içinde, hangisi daha kısa süre ise, uğrak limanlarının çıkış tarihleri ile birlikte listesi:
List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter:

Varıştaki yetkili makamın talebi üzerine, mürettebatı, yolcuları veya uluslar arası yolculuğa başlangıcından itibaren veya son otuz gün içinde hangisi daha kısa ise,
gemiye / deniz aracına binmiş diğer kişileri, bu süre zarfında uğradığı tüm limanları / ülkeleri içerecek şekilde listeleyiniz (ilave isimleri ilişikteki listeye ekleyiniz):
Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined ship/vessel since international voya
began or within past thirty days, whichever is shorter, including all ports/countries visited in this period (add additional names to the attached schedule):
İsim bindiği yer
(1) (1) (2) (3)
Name joined from:
İsim bindiği yer
(2) (1) (2) (3)
Name joined from:
İsim bindiği yer
(3) (1) (2) (3)
Name joined from:
Gemideki mürettebatın sayısı Gemideki yolcuların sayısı
Number of crew members on board 13 Number of passengers on board NIL
SAĞLIK SORULARI Health questions
Yolculuk boyunca gemide kaza sonucu olanlar dışında ölen yolcu oldu mu? Evet Hayır
If any person died on board during the voyage otherwise than as a result of accident? yes No
(1)
Evet ise, ayrıntıları ilişik tabloda belirtiniz Toplam ölü sayısı
If yes, state particulars in attached schedule. Total no.of deaths
Gemide ya da uluslar arası yolculuk esnasında bulaşıcı-mikrobik olduğundan şüphelendiğin herhangi bir hastalık var mı?
Is there on board or has there been during the international voyage any case of dissease which you suspect to be of an infectious nature?
(2)
Evet Hayır Evet ise ayrıntları ilişikte belirtiniz.
yes No If yes, state particulars in attached schedule.
Yolculuk esnasında, hasta yolcuların toplam sayısı, normalden / beklenilenden daha mı fazladır?
Has the total number of ill passengers during the voyage been greater than normal/expected?
(3)
Evet Hayır Ne kadar hasta kişi var?
yes No how many ill persons
Şu anda gemide hasta kişi var mı? Evet Hayır Evet ise ayrıntıları ilişikte belirtiniz.
(4)
Is there any ill person on board now? yes No If yes, state particulars in attached schedule.
Bir tıp doktoruna danışıldı mı? Evet Hayır Evet ise yapılan tıbbi tedavi veya önerilen ayrıntılarını ilişikte belirtiniz.
(5)
Was a medical pactitioner consulted? yes No If yes, state particulars of medical treatment or advise provided in the attached schedule
Gemide bulaşıcı-mikrobik hastalığın yayılmasına yol açabilecek bir durum biliyor musunuz?
If you aware of any condition on board which may lead to infection or spread of disease?
(6)
Evet Hayır Evet ise ayrıntları ilişikte belirtiniz.
yes No If yes, state particulars in attached schedule.
Gemide herhangi bir sağlık önlemi uygulanmış mıdır? (örn. Karantina, tecrit, dezenfeksiyon veya dekontaminasyon)
If any sanitary measure (e.g. guarantine, isolation, disinfection or decontamination) been applied on board?
(7)
Evet Hayır Evet ise, yeri, türü ve tarihini belirtiniz.
yes No If yes, specify type, place and date
Gemide kaçak yolcu bulundu mu? Evet Hayır
Have any stowaways been found on board? yes No
(8)
Evet ise, bunlar gemiye (biliniyorsa) nereden binmişlerdir.
If yes, where did they join the ship (if known)?
Gemide hasta hayvan ya da evcil hayvan bulunmakta mıdır? Evet Hayır
(9)
Is there a sick animal or pet on board? yes No
Not: Gemi tabibi yoksa, kaptan şu belirtileri, bulaşıcı-mikrobik türdeki bir hastalığın varlığından şüphelenmek için olarak dikkate almalıdır:
In the absence of a surgeon, the master should regard the following symptoms as grounds for suspecting the existance of a disease of an infectious nature:
(a) birkaç gün süren ateş ile birlikte olan; (i)bitkinlik (ii)bilinç azalması (iii)beze şişmesi (iv)sarılık (v)öksürük veya nefes darlığı (vi)alışılmadık kanamalar; (vii)f
fever, persisting for several days or accompanied by (i)prostation (ii)decreased consciousness (iii)glandular swelling (iv)jaundice (v)cough or shortness of
breath (vi) unusual bleeding; (vii)paralysis.
(b) ateşli veya ateşsiz (i) deride akut her hangi bir tipte döküntü veya pullanma (ii)ciddi kusma (deniz tutması haricinde) (iii)ciddi ishal (iv)tekrarlayan bayılmal
with or without fever; (i)any acute skin rash or eruption (ii)severe vomiting (other than sea sickness (iii)severe diarhoea or (iv)recurrent convulsions.
Ben bildiğime ve inanışlarıma göre, bu Sağlık Bildiriminde (ilişkileri ile birlikte) sorulan sorulara verdiğim cevap ve ayrıntıların doğru ve hakikate uygun olduklarını beyan ederim.
I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief.
Tarih imza Mukabil İmza
Date /10/2023 signed Kaptan Countersigned Gemi Tabibi (varsa)
Master Ship's Surgeon (if carried)
 ATIK BİLDİRİM FORMU
FORMAT OF THE WASTE NOTIFICATION FORM

Atık Bildiriminin Yapıldığı : Liman Adı / Port Name Liman Başkanlığı / Port Authority

Notification of the Waste to : ALI AGA

1 - GEMİ ÖZELLİKLERİ/SHIP PARTICULARS

1.1 Gemi Adı/Name of Ship :MOHAMMED S 1.5 Sahibi veya İşleticisi/Owner or Operator :

MANESSA MARITIME
1.6 Ayırt Edici Numarası veya Harfleri/Distincttive number or
1.2 IMO Numarası/IMO Number : 7522203
Letters :
5IM551

1.3 GRT :3307 1.7 Bayrak Devleti/Flag State :

TANZANIA

1.4 Geminin Türü/Type of Ship :

Kimyasal Tanker / Chemical
Petrol Tankeri / Oil Tanker Yük Gemisi / Bulk Carrier Ro-ro / Ro-ro
Tanker
Konteyner / Container Diğer Kargo Gemisi / Other Cargo Ship Yolcu Gemisi / Passenger Ship

Diğer / Other

2 - LİMAN VE SEFER ÖZELLİKLERİ/PORT AND VOYAGE PARTICULARS

2.1 Liman yeri ve Adı/Location/Terminal name and POC : 2.6 Atık Verilen Son Liman/Last Port Where Waste Was Delivered :

ALI AGA sagunto ABU QIR

2.2 Varış Tarihi ve Saati/ Arrival Date and Time : 2.7 Son Atık Verme Tarihi/Date of Last Delivery :

28/09/2023
2.8 Atık Verilecek Bir Sonraki Liman(biliniyorsa)/Next Port of
2.3 Kalkış Tarihi ve Saati/Departure Date and Time : /10/2023
Delivery(if known) :

2.9 Formu Dolduran Kaptan Değilse Dolduran Kişinin Adı Soyadı /

2.4 Son Liman ve Ülkesi/Last Port and Country : Person Submitting This Form is
(if other than the master) :
ABU QIR /EGYPT MASTER
2.5 Bir Sonraki Liman ve Ülkesi(biliniyorsa)/Next Port and Country(if
known) :

Tarih / Date : 01/10/2023 Adı-Soyadı ve Görevi / Name and Position :

Saat / Time : 1200 İmza / Signature :

Gemi Adı/Name of Ship : MOHAMMED S IMO Numarası/IMO Number : 7522203

Gemide kalan yaklaşık atık ve artık miktarı ile en yüksek depolama kapasitesi yüzdesini aşağıdaki tabloda belirtiniz.
Please state below the approximate amount of waste and residues remaining on board and the percantage of maximum storage capaticy.

Gemide bulunan tüm/bazı/hiçbiri atığın (aşağıdaki bildirime göre) limana verileceğini onaylıyorum / I confirm that I am delivering
all/some/none of the waste held on this vessel ( as shown table below) at this port at this port

Tümü/All Bazı/Some Hiçbiri/None

Bu atık bildirimi
ile bir sonraki
limana varış
Atık tesisine Kalan atığın arasındaki
Ayrılmış en fazla
verilecek atığın Gemide tutulan verileceği liman oluşacak tahmini Bir önceki limanda
depolama alanı/
türü ve miktarı / atık adı (biliniyorsa) / atık miktarı / verilen atık miktarı /
Maximum
Türü/Type Type and amount miktarı/Amount of Port at which Estimate amount Amount of waste
dedicated
of waste for waste retained on remaining waste of waste to be delivered at last
storage capacity
discharge to board (m3) will be delivered generated port (m3)
(m3)
facility (m3) (if known) between
notification and
next port of call
(m3)
MARPOL Ek-I - Petrol/MARPOL Annex I - Oil
Sintine Suyu/Oily bilge water 13.8 0.235 NIL 0.1
Slop/Oily Tank Washings
Slaç/Sludge 4.2 0.12 NIL 0.2
Kirli Balast/Dirty ballast water
Atık Yağ/Scale and sludge from tank
cleaning
Diğer (lütfen belirtin)/Other (please
specify)
MARPOL Ek-II/MARPOL Annex II - NLS
Kategori X (lütfen belirtin)/Category X
substance (please specify)
Kategori Y (lütfen belirtin)/Category Y
substance (please specify)
Kategori Z (lütfen belirtin)/Category Z
substance (please specify)
Diğer Maddeler (lütfen belirtin)/Other
- other substances (please specify)
MARPOL Ek-IV - Pİssu/MARPOL Annex IV - Sewage
Pis Su/Sewage NIL 14.5 2 NIL 1
MARPOL Ek-V - Çöp/MARPOL Annex V - Garbage
Plastik/Plastics 0.01 0.02 ALI AGA 0.04
Yemek Atıkları/Food wastes 0.01 0.04 ALI AGA 0.01
Evsel Atıklar/Domestic wastes 0.01 0.02 ALI AGA 0.05
Pişirme Yağı/Cooking oil 5LETER
Yakma Fırın küleri/Incinerator ashes 0.01 0.02 ALI AGA 0.01
Operasyonel atıklar/Operational
wastes
Yük artıkları/Cargo residues
Hayvan Leş(ler)/Animal carcass(es)
Balıkçılık araçları/Fishing gear
MARPOL Ek-VI Hava Kirliliği/MARPOL Annex VI - Air pollution
Ozon tabakasına zarar veren
maddeler ve bu tip maddeleri içeren
ekipmanlar/Ozone depleting
substances and equipment containing
such substances
Egzoz gazı temizleme
kalıntıları/Exhaust gas - cleaning
residues
 BALLAST WATWER REPORTING FORM
(BALAST SUYU RAPORLAMA FORMU)

TO BE PROVIDED TO HARBOUR MASTERS BEFOR ARRIVAL

(LİMAN BAŞKANINA LİMANA GİRMEDEN ÖNCE GÖNDERİLECEKTİR)

2.BALLAST WATER(BALAST)
1. VESSEL INFORMATION (GEMİ BİLGİLERİ) Specify Units:m3,MT,LT (Birimleri m3,MT,LT cinsinden belirtin)
Vessel name : Type: Total Ballast Water on Board:
(Gemi adı) MOHAMMED S (Gemi Tipi) C .CARGO (Gemide mevcut balast miktarı) 9
Owner: Grt: Total ballast Water Capacity:
MANESSAA (Gros ton) 3307 (Geminin balast alma kapasitesi)
(Gemi sahibi) 937 MT
Flag: Arrival Date:
(Bayrağı) ZANZIBAR (Varış Tarihi) /10/2023 3.BALLAST WATER TANKS (BALAST TANKLARI)
Arrival Port: Ballast Water Manegment Plan on board? ….Yes / No
(Varış Limanı) ALI AGA (Gemide Balast Yönetim Planı Var mı?)....Evet / Hayır
Last Port and Country :
ABU QIR-EGYPT
(Geldiği Liman ve Ülke) IMO No: Total No of Ballast Tanks on board:
(IMO numarası) 7522203 (Gemide bulunan blast tank sayısı) NIL
Call Sign: No of Tanks in ballast:
(Çağrı İşareti) 5IM551 (balast dolu tank sayısı)
Next Port and Country : NIL
ALI AGA -TURKEY
(Gideceği Liman ve Ülke) Agent: No of Tanks exchanged:
(Acenta) LBH (Balast değişimi yapılmış tank sayısı) NIL
No of Tanks not exchanged:
(balast değişimi yapılmamış tank sayısı) NIL
4.BALLAST WATER HISTORY (BALAST KAYIT):
Record All Tanks That Will Be Deballasted In Port State Of Ariival; If None Go To 5 (Varış limanında boşaltılacak tüm balast tankları kayıt altına alınacaktır. Eğer yoksa 5'e geçin)
Tanks/Holds (list
multiple sources/tanks BW SOURCE (BALAST ALIMI) BW EXCHANGE (BALAST DEĞİŞİMİ) BW DISCHARGE (BALAST BASIMI)
separately)
Tanklar/Ambarlar (Tek Date(DD/MM/YY) Port or Lat.Long. Volume Temp Date(DD/MM/YY) End Point Lat.Long. Volume Salinity Date(DD/MM/YY) Port or Lat.Long. Volume Salinity
Tek belirtilecek) Tarih(GG/AA/YY) Liman veya Koordinat Miktar Sıcaklık Tarih(GG/AA/YY) Liman veya Koordinat Miktar Tuzluluk Tarih(GG/AA/YY) Liman veya Koordinat Miktar Tuzluluk
FP NIL
DB 1 P*S NIL
DB 2P*S NIL
D B 3 P*S NIL
D B 4 P*S NIL
AP NIL

Ballast Water Tank Codes: Forepeak=FP, Aftpeak=AP, Double Bottom=DB, Wing=WT, Topside=TS, Cargo Hold=CH, O=Other
Balast Tank kodları : Başpik=FP, Kıçpik=AP,Diptank=DB, Asmatank=WT, Yantank=TS, Ambar=CH, Diğer=O
5. IMO BALLAST WATER GUIDELINES ON BOARD (RES.A20/868)? (Gemide RES.A20/868 simgeli IMO rehberi Yes(evet)
V No(hayır)

(sorumlu personelik ismi ünvanı ve imzası) Master of

Capt.
 DAT
SEAMANBOO
PASSPORT PASSPORT SEAMANBOO DATE OF E OF
K EXPIRE NAME SURNAME COUNTRY RANK JOB
NUMBER EXPIRE DATE K NUMBER BIRTH PLA
DATE
CE

N015348206 18/04/2028 40742 21/04/2025 MALEK JUNDI SYRIAN 27/09/1975 MASTER

A32816645 1/22/2028 S00028409 1/2/2028 SAAD ATTIA PORT SAIDA 11/14/1991 CH OFF
A29997103 2/28/2029 S00031216 5/20/2028 MAHMOUD ELZAMEK TARTUS 2/12/1963 CH ENG
A33898829 5/28/2023 S00027151 11/22/2027 IBRAHIM TARABIA DAMIETTA 7/5/1961 2N ENG
A24675347 4/9/2026 S00027437 12/12/2027 MOHAMED OTHMAN DAMIETTA 1/27/1971 BOSS
A30983151 1/8/2029 S00033668 9/8/2028 MOHAMED ELSHENAWY ALEXANDRIA 21/03/1997 A/B
A21981085 12/29/2024 S00012157 12/19/2025 AHMED ABOUOMAR DAMIETTA 11/28/1994 A/B
A33208989 2/22/2030 S00018560 10/10/2026 MAHMOUD TARABIA DAMIETTA 7/7/1993 OLIR
A35198887 22/09/2030 S00034538 5/9/2028 MOHAMED ABD ELALIM ALEXANDRIA 2/9/2001 A/B
A33879437 5/2/2030 S00030647 4/26/2028 YOUSSEF ELFALAH DAMIETTA 1/1/2001 A/B
A28009839 16/02/2028 S00027197 27/11/2027 SAAD ABDELMAGID DAMIETTA 26/11/1993 OILER
A34571768 1/8/2030 S00032511 5/7/2028 KAREM KANAD DAMIETTA 28/01/2000 OILER
A30431410 4/27/2023 S00030327 5/4/2028 ESLAM ELALILY ALEXANDRIA 5/5/2001 COOK
 ID
NUMBE
R
 PREARRIVAL INFORMATION TO BE PROVIDED BY SHIP INTENDING TO
ENTER PORT OF
FORM A

1) Internetional Ship Security Certificate ( ISSC )or Interim ISSC YES

Inssuing Authority
Dates of Issue and Expire

2) The curent security level of the ship : ONE (1)

3) The security levels in the previous ten call at port facilites : ONE (1)

Port, Country, Port Facility and UNLOCODE Date of arrival S/L Date of departure Operation
1 BENGAZI 18/04/2023 9/5/2023
2 SAIDA 16/05/2023 18/05/2023
3 ISKENDRUN 19/05/2023 25/05/2023
4 ALEX 28/05/2023 22/06/2023
5 DERNAH 24/06/2023 24/07/2023
6 ISKENDRUN 28/07/2023 21/08/2023
7 MERSIN 22/08/2023 26/08/2023
8 DURRES 31/08/2023 5/9/2023
9 GULLUK 8/9/2023 20/09/2023
10 ABU QIR 22/09/2023 1/10/2023

4) Any special or additional security measure taken by the ship in any previous port
where it has conducted a ship/portinterface during the period covered by previous ten
call at port facilities. ( NO )
a) Measures taken while visiting a port facility located in the territori of a state
wihich is not a Contracting Government. ( NO )
b) Any declarations of Security that were entered into with port facilities or other
ships. ( NO )

5) Confirmation that appropriate ship security procedures were maintained during any
ship - to - ship activity during the period covered by previous ten call at port facilities.

a) Measures taken while engaged in a ship - to - ship activity with a ship flying the
flag of a State which is not a Contracting Government . ( NO )

b) Measures teken while engaged in a ship - to - ship activity with a aship flying the
flaf of a Conntracting Government but not required to comply with the
provisions of chapter XI - 2 and part A of the ISPS Code. ( NO )

c) In the event that persons or goods rescued at sea are on board, all known
information about such persons or goods,including their identies when known
and the results of any checks run on behalf of the ship to establish the security
 CREW'S EFFECTS AND CURRENCY DECLARATION LIST

ARRIVAL X DEPARTURE
1. Name of Ship MOHAMMED S 2. Port of Arrival ALI AGA

4.Nationality of ship TANZANIA 5. Port Departure ABU QIR

Porn
o,
arms Cigaret
Spirits
6. No 7.Family name; Given names 8.Rank or rating , Money tes
Ltrs
narc CRT
otics
1 MALEK JUNDI MASTER . NIL NIL 200

2 SAAD ATTIA CH OFF NIL NIL 200

3 MAHMOUD EL ZAMEK CH ENG NIL NIL 200

4 IBRAHIM TARABIA 2ND ENG NIL NIL 200

5 MOHAMED OTHMAN BOOS NIL NIL 200

6 MOHAMED ELSHENAWY A/B NIL NIL 200

AHMED ABOUOMAR NIL

7
A/B NIL 200
MAHMOUD TARABYA NIL 200
8
A/B NIL
MOHAMED ABD ELALIM A/B
9
NIL NIL 200
YOUSSEFELFALAH A/B NIL 200
10
NI;
SAAD ABDELMAGID OILER
11
NIL NIL 200
KAREM KANAD OILER
12
NIL NIL 200
COOK 200
13
ESLAM ELALILY NIL NIL
10. Date and signature by master, authorized agent or officer
N LIST

Page No.1
3. Date of arrival/departure

/10/2023

Personnel Effects 9.Signature

2 MOBAIL+LAB
TOB

1M PHONE+LAP
TOP
1M PHONE

1M PHONE

1M PHONE+LAP
TOP
1M PHONE

1M PHONE

1M PHONE

1M PHONE

1M PHONE

1M PHONE

1M PHONE

1 PHONE

MASTER
 IMO SHIP'S STORES DECLARATION
Ar Departur Page 1
1 Name of ship/MOHAMMED S 2 3 Date of arrival / departure

/10/2023
4 Nationality of ship /TANZANIA 5 Port of Departure 7 Master name

ABOU QIR MALEK JUNDI

8 Number of persons on board 13 9 Perio 11 Place of storage

12 Name of article 13 Quantity 14 For official use

PROVISION BONDED STORE
CIGARETTES 70 CRT
SPRITS NIL bottles
BEER NIL
VINE NIL
NIL

Equipments
PYROTECHNICS
Line throwing apparatus (bridge) pcs
Red parachute rockets (bridge) pcs
Orange smoke signal (bridge) pcs
SHIP'S INVENTORY
Portable radio pc
Tv color pcs
Photocopy machine+printer pcs
Computer pcs
Binecular pcs
Refrigerator pcs
Electrical fan pcs
Washing mashine pcs
Drying mashine pcs
Welding mashine pcs
Dvd player pcs
BUNKER Walky-Talky pcs
HYDROLIC OIL : 400 KG D/O:47000 L Sattalite&antenna pc
GEAR OIL : 100 KG L/O: 600 KG Iron pc
BILGE TANK : FW: 20 MT Water boiler pcs
SLUDGE TANK : Gsm phone pc
AND ALL OTHER ARTICLES AND EQUIPMENT FOR SAFE WORKING AND NAVIGATION OF THE VESSEL
15 Date and Signature by Master, authorized Agent or Officer

MASTER
 NIL LIST

PLS ISSUE NIL LIST