| • |
A |
Vessel's Name / Flag / Call Sign / IMO No / MMSI No |
| • |
B |
Date/Time (Reporting Date/Time) |
| • |
C |
Position (Reporting Position) |
| • |
F |
Max Maneuvering And Sea Speed |
| • |
G |
Port Of Departure |
| • |
H |
Date/Time And Point Of Entry Into Traffic Separation Scheme |
| • |
I |
Port Of Destination |
| • |
J |
Pilot Requirements |
| • |
O |
Fwd / Aft Drafts And Air Draft |
| • |
P |
Cargo (Type And Quantity Of Cargo) |
| • |
Q |
Defects/Damage/Deficiencies/Other Limitations |
| • |
R |
Description And Un Or Imo Number Of Dangerous Cargo On Board |
| • |
T |
Vessel's agent name |
| • |
U |
Ship's Type / LOA / GT / NT / DWT / Present Displacement |
| • |
W |
Total number of crew on board and Name of Captain |
| • |
X |
P And I Policy Number And Due Date |
| • |
|
Bunker on arrival FO - DO – LO |
| • |
|
Construction Date |
| • |
|
Last PSC port and date |
