This Form Is To Be Submitted To The Port Authorities Prior To The Arrival of The Vessel

Pre-Arrival Notification of Security (PANS) for:
a) Passenger ships including high speed passenger craft,

b) Cargo ships, including high-speed craft, of 500 GRT and upwards, and
c) Mobile offshore drilling units.
This form is to be submitted to the port authorities prior to the arrival of the vessel.
1. Particulars of the ship and contact details
1.1 IMO Number: 1.2 Name of the ship:
1.3 Port of registry: 1.4 Flag State: 1.5 Type of ship:
1.7 Inmarsat call Numbers: 1.8 Gross Tonnage: :

1.6 Call sign:
1.9 Name of Company.
1.10 Name and 24 hour contact details of Company Security Officer:

Name :
2. Port and port facility information
2.1 Port of arrival and port facility where the ship is to berth, if known : KOCHI
2.2 Expected date and time of arrival of the ship in port (paragraph B/4.39.3 of the ISPS Code:.
2.3 Primary purpose of call: Cargo operation
If others, pleases specify purpose: ………………………………………………………………………………
Page 1 of 5
3. Information required by SOLAS regulation XI-2/9.2.1
3.1 The ship is provided (SOLAS REGULATION 9.2.1.1) with a valid:
International Ship Security Certificate YES NO
Interim International Ship Security Certificate YES NO
3.1.1 Certificate indicated in 3.1 has been issued by:
Name of issuing authority :JEJU REGIONAL MARITIME AFFAIRS & FISHERIES OFFICE
Date of expiry: 08TH APR 2009
3.1.2 If the ship is not provided with a valid International Ship Security Certificate or a valid Interim
International Ship Security Certificate, explain why?
3.1.2.1 Does the ship have an approved ship security plan on board? YES NO
3.2 Current security level (SOLAS regulation XI-2/9.2.1.2): 1(ONE)
3.2.1 Location of ship at the time the report is made (paragraph B/4.39.2 of the ISPS Code):
Latitude: …13-55N ……. Longitude: …051-33E……… or Port: ……………………………
Date Security
No Port, Country, Port Facility and UNLOCODE level
From To
1
2
3
4
5
6
7
8
9
10
3.3 List the last 10 calls in chronological order with the most recent call first, at port facilities at which
the ship conducted ship/ port interface together with the security level at which the ship operated
(SOLAS regulation XI-2/9.2.1.3):
Page 2 of 5
3.3.1 Did the ship, during the period specified in 3.3, take any special or additional security measures,
beyond those specified in the approved ship security plan?
Date Special or additional

No Port, Country, Port Facility and UNLOCODE
From To measures
1
2
3
4
5
6
7
8
9
10
YES NO
3.3.2 If your answer to 3.3.1. is YES, for each of such occasions please indicate the special or
additional security measures which were taken by the ship (SOLAS regulation XI-2/9.2.1.4):
Date
No Port, Country, Port Facility and UNLOCODE Ship-to-ship Activity
3.4 From To
List 1
the
2
3
4
5
6
7
8
9
10
ship to ship activities in chronological order with the most recent ship- to- ship activity first, which have
been carried out during the period specified in 3.3:
NOT APPLICABLE
Page 3 of 5
3.4.1 Have the ship security procedures, specified in the approved ship security plan, been maintained
Date Ship-to-ship
No Security measures applied
From To activity
1
2
3
4
5
6
7
8
9
10
during each of the ship-to-ship activities specified in 3.4 (SOLAS regulation XI-2/9.2.1.5)?
YES NO
3.4.2 If the answer to 3.4.1. is NO, identify the ship to ship activities for which the ship security
procedures were not maintained and indicate, for each, the security measures which were applied in
lieu:
3.5 Provide a general description of cargo aboard the ship (SOLAS regulation XI-2/9.2.1.6 and
paragraph B/4.39.5 of the ISPS Code):
PHOSPHATE ROCK / 44,844MT
3.5.1 Is the ship carrying any dangerous substances as cargo? YES NO
3.5.2 If the answer to 3.5.1. is YES, provide details or attach a copy of the Dangerous Goods Manifest
(IMO FAL FORM 7)
Page 4 of 5
3.6 A copy of the ship’s Crew List (IMO FAL Form 5 is attached)
(SOLAS regulation XI-2/9.2.1.6 and paragraph B/4.39.4 of the ISPS Code) YES
3.7 A copy of the ship’s Passenger List (IMO FAL Form 6 is attached)
(SOLAS regulation XI-2/9.2.1.6 and paragraph B/4.39.6 of the ISPS Code) NOT APPLICABLE
4. Other security related information
4.1 Is there any security related matter you wish to report? YES NO
4.1.1 If the answer to 4.1 is YES, provide details:
5. Agent of the ship at the intended port of arrival
5.1 Name and 24-hour contact details of Agent in intended port of call:
6. Identification of the person providing the information
6.1 Name: …………

6.2 Title or position: …………………………………………………………………………………..
6.3 Signature: …
This report is dated at (Place)

On (Date and time) :
Page 5 of 5
Name & Phone no. of vessel security officer :

Name & Phone no. of Company security officer :
Inter National Ship Security Certificate No. :
Inter National Ship Security Certificate Date of Issue :
Inter National Ship Security Certificate Date of Expiry :

This Form Is To Be Submitted To The Port Authorities Prior To The Arrival of The Vessel

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Pre-Arrival Notification of Security (PANS) for:

a) Passenger ships including high speed passenger craft,

1. Particulars of the ship and contact details

1.1 IMO Number: 1.2 Name of the ship:

1.3 Port of registry: 1.4 Flag State: 1.5 Type of ship:

1.7 Inmarsat call Numbers: 1.8 Gross Tonnage: :

1.9 Name of Company.

1.10 Name and 24 hour contact details of Company Security Officer:

2. Port and port facility information

2.3 Primary purpose of call: Cargo operation

If others, pleases specify purpose: ………………………………………………………………………………

3.1 The ship is provided (SOLAS REGULATION 9.2.1.1) with a valid:

International Ship Security Certificate YES NO

Interim International Ship Security Certificate YES NO

3.1.1 Certificate indicated in 3.1 has been issued by:

Date of expiry: 08TH APR 2009

3.2 Current security level (SOLAS regulation XI-2/9.2.1.2): 1(ONE)

Latitude: …13-55N ……. Longitude: …051-33E……… or Port: ……………………………

Date Special or additional

3.5.1 Is the ship carrying any dangerous substances as cargo? YES NO

4. Other security related information

4.1.1 If the answer to 4.1 is YES, provide details:

5. Agent of the ship at the intended port of arrival

6. Identification of the person providing the information

6.1 Name: …………

This report is dated at (Place)

Name & Phone no. of vessel security officer :

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