<%@ Language=VBScript %> <% Option Explicit %> Application for the use of Port Facilities

APPLICATION FOR USE OF PORT FACILITIES

This form is to be completed IN FULL and lodged within 2 clear working days in order for a berth and services to be allocated.

Please note that ALL fields are required to be completed. ( if information is unavailable, enter a ? or N/A )

Port
Allot berth for: MV Lloyd's No
Master Berth Requested
Voyage No - In Out
P & I Club Name

VESSEL PARTICULARS
Port of Registry Gross Tonnage
Breadth Length O.A.
Bow to Bridge
Bow Thrusters  YES NO HP
Summer Draft. Deadweight Tonnage
       

SHIP SECURITY
Ship Security Level Security Certificate No
       
  Last 3 Ports Visited

Security Compliant ?

 Level of Port Security
1.  YES NO
2.  YES NO
3.  YES NO

ARRIVAL FROM
Country Arrival Draft
Port
Inward Cargo Tonnes
Cargo Summary
Date Time

DEPARTURE TO
Country Departure Draft
Port
Outward Cargo Tonnes
Cargo Summary
Date Time

SERVICES REQUIRED
Pilot  YES NO Water  YES NO
Electricity  YES NO Quarantine Waste  YES NO

Navigation Service Charge 

Inward Cargo Agents (Abbr) 1. 2. 3. 4. 5.
Outward Cargo Agents (Abbr) 1. 2. 3. 4. 5.
Ships Agent: IN OUT BOTH    (Select applicable)
 
Shipping Line
Email Address Agency
Allocated Stevedore Fax Number