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General Declaration: Vessel Particulars GDV No

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GENERAL DECLARATION

*Application for Arrival & Departure


Arrival
Departure
VESSEL PARTICULARS GDV NO.
Name *Charterer

Callsign

Type 1 1 Singaporean

Nationality/Flag 2 2 Non-Singaporean

Port of Registry 3 3 Nil

Certificate of
Registry No.
Gross Register Tons / Gross Ton * Purpose

Net Register Tons

Name of Shipping Line/Owner 1 1


Cargo Operation
Country of Shipping Line/Owner 2 2 Embarking/Disembarking Passenger

Master 3 3 Taking Bunkers

Deadweight Capacity at Summer 4 4


Mark (to nearest tone) Taking Supplies
Name & Address of Agent 5 5 Changing Crew

6 6 Repair/Docking/Outfitting

9 9
Other, please specify:

If Taking Bunkers, state:-

Quantity Taken: tonnes

Tel A/C Grade of Bunkers@:MDO/MGO/MFO cst


No. No.
ARRIVAL D D M M Y Y H H M M Location Grid Ref

Date & Time Position


in Port
Arrived from Number of Passengers

Total Cargo (Freight Tonne) Work Cargo or Embark/Disembark Passenger(s) on Arrival ++

DEPARTURE D D M M Y Y H H M M

Date & Time Next Port

Number of Crew (incl. Master) Number of Passengers

Total Cargo (Freight Tonne) Work Cargo or Embark/Disembark Passenger(s) before Departure ++

*SUBMISSION OF DOCUMENTS

2 copies av General Declaration 1

ON ARRIVAL: FOR DEPARTURE:


1. 1 copy of Last Port Clearance 2 1. 2 copies of Crew List+ 5
2. Certificate of Civil Liability+ 3 2. 2 copies of Passenger List+ 6
3. Certificate of Fitness+ 4

I declare that the information given above is true and correct.

Date Authorised Agent/Master of the Vessel


* Tick ( ) where applicable + + Indicate 'Y' if Yes; 'N' if No
+ To submit if applicable @ Delete whichever not applicable

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