1 Crew List

2 Passport List
3 Sign on Crew List
4 Passengers List
5 Vaccination List
6 Crew Effects Declaration
7 Nill List
8 Ship Stores Declaration
9 Cargo Declaration
10 Ports of Call List
11 Crew Money List Declaration
12 Ship's Cash List
13 Maritime Declaration of Health
14 Ship's Pyrotechnics List
15 Narcotic's List
16 General Declaration
Mv : QUEEN LILA
Flag : Belize
Date: 07.06.2019

BASIC LIST

DATE OF PLACE OF
NUM SURNAME OTHER NAME RANK NAT/TY BIRTH BIRTH
1 ABDULLATEEF.OSAYLEE MASTER SYRIAN 24.03.1955 TARTOUS
2 MAHMOUD, HAJJAR CH/OFF SYRIAN 13.03.1986 LATAKIA
3 BASHAR.JARKAS 2ND/OFF SYRIAN 20.01.1995 TARTOUS
4 BASHIR SUBHI SULEIMAN ABU HAMEEDAH 2ND/OFF2 JORDAN 10.11.1989 AMMAN
5 MOHAMAD,MUALLA CH/ENG SYRIAN 15.07.1979 TARTOUS
6 MAHMOUD AMMOUN 2ND ENG SYRIAN 13.02.1975 LATAKIA
7 SALEM, JAMAL 3rd/ENG SYRIAN 05.09.1990 TARTOUS
8 HUSSEIN,KANAFANI 3rd/ENG SYRIAN 04.04.1994 TARTOUS
9 MAHMOD YASEER ELECTR. SYRIAN 12.06.1993 LATAKIA
10 MOHAMMAD CHEIKH YOUSEF A/B1 SYRIAN 15.09.1977 LATAKIA
11 MOUFAK,HEJAZI A/B2 SYRIAN 01.01.2000 TARTOUS
12 MUSTAFA,HAMMOUDEH A/B3 SYRIAN 11.04.1997 TARTOUS
13 MOHAMAD WALID, JENNIAT A/B4 SYRIAN 01.01.2000 HOMS
14 MOHAMMAD, MERJANEH A/B5 SYRIAN 17.02.1992 TARTOUS
15 SUDHIR ASHOK TIWARI D.CADET INDIAN 10.09.1997 PANTA,BIHAR
16 MOHAMAD,ZEIN OILER1 SYRIAN 19.06.2000 TARTOUS
17 ABDULKADER,MUHIEDDIN OILER2 SYRIAN 01.04.1983 TARTOUS
18 MOHAMMED SHAHIN NIZAR E.CADET INDIAN 02.08.1995
THIRUVANANTHAPURAM,KERALA
19 SAFWAN , ALSAROUT FITTER SYRIAN 12.05.1980 LATTAKIA
20 KABI,FARRAN COOK SYRIAN 03.12.1981 TARTOUS
21 ABDUL RAHMAN ABO CHER MALKE M.BOY SYRIAN 04.09.2001 K.S.A
22 RAVI SHANKAR. M M.BOY INDIAN 08.02.1994
PULIYOOR KURICH,TAMINADU
23
24

DATE
11/06/2019
ASIC LIST
S/BOOK
PASSPORT S/BOOK DATE PLACE YELLOW P/PORT EXPIRED
NO. NO. SIGN On SIGN On FEVER CHOLERA EXP.DATE DATE
N 011772412 000027834 07.02.2020ALEXANDARIA 15.02.2019 15.02.2019 01.07.2023 15.10.2022
N 010410825 000032393 30.04.2019 SINGAPORE 04.04.2019 04.04.2019 22.08.2021 27.03.2022
N 012798504 000024821 07.02.2020ALEXANDARIA 26.07.2016 27.07.2016 29.09.2024 28.12.2021
N 598382 K 758279 30.04.2019 SINGAPORE 19.03.2019 06.02.2019 24.10.2020 30.08.2020
N 011054487 000034257 07.02.2020ALEXANDARIA 17.06.2019 17.06.2019 21.06.2022 18.10.2023
N 013707637 000027115 30.04.2019 SINGAPORE 03.07.2017 03.07.2017 27.11.2025 06.03.2025
N 012798480 000028341 30.04.2019 SINGAPORE 21.11.2016 04.04.2019 28.09.2024 14.11.2022
N 012796161 000038262 07.02.2020ALEXANDARIA 08.04.2019 08.04.2019 18.08.2024 25.08.2024
N 013665354 000027210 30.04.2019 SINGAPORE 13.11.2019 13.11.2019 05.11.2025 30.08.2022
N 011996275 000033741 07.02.2020ALEXANDARIA 18.11.2019 18.11.2019 26.08.2023 12.09.2023
N 013817465 000032431 07.02.2020ALEXANDARIA 28.12.2017 28.12.2017 15.01.2022 03.06.2023
N 013258865 000040689 07.02.2020ALEXANDARIA 08.04.2019 08.04.2019 07.04.2025 30.03.2025
N 013608604 000025292 30.04.2019 SINGAPORE 10.10.2019 10.10.2019 22.09.2021 12.03.2022
N 013017523 000023861 30.04.2019 SINGAPORE 24.01.2019 24.01.2019 25.11.2020 12.08.2021
S 2243808 MUM 347885 30.04.2019 SINGAPORE 15.10.2017 15.10.2017 05.04.2028 14.09.2027
N 013817662 000037768 07.02.2020ALEXANDARIA 08.04.2019 08.04.2019 22.01.2022 02.12.2024
N 012350446 000035434 07.02.2020ALEXANDARIA 16.05.2018 16.05.2018 03.04.2024 19.02.2024
P 0428795 MUM 321574 30.04.2019 SINGAPORE 20.02.2019 20.02.2019 22.08.2026 06.12.2028
N 013377310 000039909 30.04.2019 SINGAPORE 04.04.2019 04.04.2019 21.05.2025 17.12.2023
N 013707124 000043624 07.02.2020ALEXANDARIA 28.12.2017 28.12.2017 17.11.2025 20.11.2025
N 013609961 000043394 30.04.2019 SINGAPORE 07.11.2019 07.11.2019 14.10.2021 20.10.2025
M9533588 MUM256567 30.04.2019 SINGAPORE 27.09.2018 27.09.2018 27.05.2025 26.08.2028

Capt. Haytham Meamari

US VISA US VISA
EXPIRED DATE
DATE ISSUE
 CREW LIST ✘ Arrival Departure Page No. 1
1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure
QUEEN LILA PORT HARCOURT 4/16/2020
4. Nationality of ship 5. Port arrived from
Belize GIBRALTAR identity document

7. No 8. GIVEN NAME .FAMILY NAME 9. Rank or rating 10. Nationalit 11. Date and place of birth (Seamans Book)

1 ABDULLATEEF.OSAYLEE MASTER SYRIAN 24.03.1955 TARTOUS 000027834

2 MAHMOUD, HAJJAR CH/OFF SYRIAN 13.03.1986 LATAKIA 000032393

3 BASHAR.JARKAS 2ND/OFF 1 SYRIAN 20.01.1995 TARTOUS 000024821

4 BASHIR SUBHI SULEIMAN ABU HAMEEDAH 2ND/OFF 2 JORDAN 10.11.1989 AMMAN 2958

5 MOHAMAD,MUALLA CH/ENG SYRIAN 15.07.1979 TARTOUS 000034257

6 MAHMOUD AMMOUN 2ND ENG SYRIAN 13.02.1975 LATAKIA 000027115

7 SALEM, JAMAL 3rd/ENG SYRIAN 05.09.1990 TARTOUS 000028341

8 HUSSEIN,KANAFANI 3rd/ENG SYRIAN 04.04.1994 TARTOUS 000038262

9 MAHMOD YASEER ELECTR. SYRIAN 12.06.1993 LATAKIA 000027210

10 MOHAMMAD CHEIKH YOUSEF A/B1 SYRIAN 15.09.1977 LATAKIA 000033741

11 MOUFAK,HEJAZI AB/1 SYRIAN 01.01.2000 TARTOUS 000032431

12 MUSTAFA,HAMMOUDEH AB/2 SYRIAN 11.04.1997 TARTOUS 000040689

13 MOHAMAD WALID, JENNIAT AB/3 SYRIAN 01.01.2000 HOMS 000025292

14 MOHAMMAD, MERJANEH AB/4 SYRIAN 17.02.1992 TARTOUS 000023861

15 SUDHIR ASHOK TIWARI D.CADET INDIAN 10.09.1997 PANTA,BIHAR MUM 347885

16 MOHAMAD,ZEIN OILER1 SYRIAN 19.06.2000 TARTOUS 000037768

17 ABDULKADER,MUHIEDDIN OILER2 SYRIAN 01.04.1983 TARTOUS 000035434

18 MOHAMMED SHAHIN NIZAR E.CADET INDIAN 02.08.1995 THIRUVANANTHAPURAM,KERALA MUM 321574

19 SAFWAN , ALSAROUT FITTER SYRIAN 12.05.1980 LATTAKIA 000039909

20 KABI,FARRAN COOK SYRIAN 03.12.1981 TARTOUS 000043624

21 ABDUL RAHMAN ABO CHER MALKE M.BOY SYRIAN 04.09.2001 K.S.A 000043394
22 RAVI SHANKAR. M M.BOY INDIAN 08.02.1994 PULIYOOR KURICH,TAMINADU MUM256567

12. Date and signature by master,authorized agent or officer

MASTER:
 CREW LIST ✘ Arrival Departure Page No. 1
1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure
QUEEN LILA 5/12/2020
4. Nationality of ship 5. Port arrived from 6. Nature and No. of 7. Identity document
Belize identity document expiry date

8. No 9. Family name,given names 10. Rank or rating 11. Nationality 12. Date and place of birth (Passport) (Passport)

1 ABDULLATEEF OSAYLEE MASTER SYRIAN 24.03.1955 TARTOUS N 011772412 01.07.2023

2 MAHMOUD, HAJJAR CH/OFF SYRIAN 13.03.1986 LATAKIA N 010410825 22.08.2021

3 BASHAR.JARKAS 2ND/OFF SYRIAN 20.01.1995 TARTOUS N 012798504 29.09.2024

4 BASHIR SUBHI SULEIMAN ABU HAMEEDAH 2ND/OFF2 JORDAN 10.11.1989 AMMAN N 598382 24.10.2020

5 MOHAMAD,MUALLA CH/ENG SYRIAN 01.08.1970 TARTOUS N 011054487 21.06.2022

6 MAHMOUD AMMOUN 2ND ENG SYRIAN 13.02.1975 LATAKIA N 013707637 27.11.2025

7 SALEM, JAMAL 3rd/ENG SYRIAN 05.09.1990 TARTOUS N 012798480 28.09.2024

8 HUSSEIN,KANAFANI 3rd/ENG SYRIAN 04.04.1994 TARTOUS N 012796161 18.08.2024

9 MAHMOD YASSER ELECTR. SYRIAN 12.06.1993 LATAKIA N 013665354 05.11.2025

10 MOHAMMAD CHEIKH YOUSEF A/B1 SYRIAN 15.09.1977 LATAKIA N 011996275 26.08.2023

11 MOUFAK,HEJAZI A/B2 SYRIAN 01.01.2000 TARTOUS N 013817465 15.01.2022

12 MUSTAFA,HAMMOUDEH A/B3 SYRIAN 11.04.1997 TARTOUS N 013258865 07.04.2025

13 MOHAMAD WALID, JENNIAT A/B4 SYRIAN 01.01.2000 HOMS N 013608604 22.09.2021

14 MOHAMMAD, MERJANEH A/B5 SYRIAN 17.02.1992 TARTOUS N 013017523 25.11.2020

15 SUDHIR ASHOK TIWARI D.CADET INDIAN 10.09.1997 PANTA,BIHAR S 2243808 05.04.2028

16 MOHAMAD,ZEIN OILER1 SYRIAN 19.06.2000 TARTOUS N 013817662 22.01.2022

17 ABDULKADER,MUHIEDDIN OILER2 SYRIAN 01.04.1983 TARTOUS N 012350446 03.04.2024

18 MOHAMMED SHAHIN NIZAR E.CADET INDIAN 02.08.1995 THIRUVANANTHAPURAM,KERALA P 0428795 22.08.2026

19 SAFWAN , ALSAROUT FITTER SYRIAN 12.05.1980 LATTAKIA N 013377310 21.05.2025

20 KABI,FARRAN COOK SYRIAN 03.12.1981 TARTOUS N 013707124 17.11.2025

21 ABDUL RAHMAN ABO CHER MALKE M.BOY SYRIAN 04.09.2001 K.S.A N 013609961 14.10.2021

22 RAVI SHANKAR. M M.BOY INDIAN 08.02.1994 PULIYOOR KURICH,TAMINADU M9533588 27.05.2025

12. Date and signature by master,authorized agent or officer

MASTER:
 SIGN ON CREW LIST ✘ Arrival Departure Page No. ___

1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure

QUEEN LILA
4. Nationality of ship 5. Port arrived from 6. Nature and No. of
Belize identity document

7. No 8. Family name,given names 9. Rank or rating 10. Nationality 11. Date and place of Sign on (Seamans Book)

1 ABDULLATEEF.OSAYLEE MASTER SYRIAN 07.02.2020 ALEXANDARIA 000027834

2 MAHMOUD, HAJJAR CH/OFF SYRIAN 30.04.2019 SINGAPORE 000032393

3 BASHAR.JARKAS 2ND/OFF SYRIAN 07.02.2020 ALEXANDARIA 000024821

4 BASHIR SUBHI SULEIMAN ABU HAMEEDAH 2ND/OFF2 JORDAN 30.04.2019 SINGAPORE K 758279

5 MOHAMAD,MUALLA CH/ENG SYRIAN 07.02.2020 ALEXANDARIA 000034257

6 MAHMOUD AMMOUN 2ND ENG SYRIAN 30.04.2019 SINGAPORE 000027115

7 SALEM, JAMAL 3rd/ENG SYRIAN 30.04.2019 SINGAPORE 000028341

8 HUSSEIN,KANAFANI 3rd/ENG SYRIAN 07.02.2020 ALEXANDARIA 000038262

9 MAHMOD YASEER ELECTR. SYRIAN 30.04.2019 SINGAPORE 000027210

10 MOHAMMAD CHEIKH YOUSEF A/B1 SYRIAN 07.02.2020 ALEXANDARIA 000033741

11 MOUFAK,HEJAZI A/B2 SYRIAN 07.02.2020 ALEXANDARIA 000032431

12 MUSTAFA,HAMMOUDEH A/B3 SYRIAN 07.02.2020 ALEXANDARIA 000040689

13 MOHAMAD WALID, JENNIAT A/B4 SYRIAN 30.04.2019 SINGAPORE 000025292

14 MOHAMMAD, MERJANEH A/B5 SYRIAN 30.04.2019 SINGAPORE 000023861

15 SUDHIR ASHOK TIWARI D.CADET INDIAN 30.04.2019 SINGAPORE MUM 347885

16 MOHAMAD,ZEIN OILER1 SYRIAN 07.02.2020 ALEXANDARIA 000037768

17 ABDULKADER,MUHIEDDIN OILER2 SYRIAN 07.02.2020 ALEXANDARIA 000035434

18 MOHAMMED SHAHIN NIZAR E.CADET INDIAN 30.04.2019 SINGAPORE MUM 321574

19 SAFWAN , ALSAROUT FITTER SYRIAN 30.04.2019 SINGAPORE 000039909

20 KABI,FARRAN COOK SYRIAN 07.02.2020 ALEXANDARIA 000043624

21 ABDUL RAHMAN ABO CHER MALKE M.BOY SYRIAN 30.04.2019 SINGAPORE 000043394

22 RAVI SHANKAR. M M.BOY INDIAN 30.04.2019 SINGAPORE MUM256567

12. Date and signature by master,authorized agent or officer

MASTER:
 PORTS OF CALL LIST ✘ Arrival Departure Page No. 1
1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure
QUEEN LILA PORT HARCOURT 3/6/2020
4. Nationality of ship 5. Port arrived from
Belize GIBRALTAR
7. No 8. Port name and country 8. Arrival date 9. Departure date 11. Reason of call 12. Security Level

1 GIBRALTAR 01.03.2020 02.03.2020 BUNKERING 1(ONE)

2 MERSIN TURKEY 14.02.2020 23.02.2020 LOADING 1(ONE)

3 ALEXANDRIA .EGYPT 28.01.2020 11.02.2020 DISCHARGING 1 (ONE)
4 NYKOLAYEV , UKRAINE 19.01.2020 22.01.2020 LOADING 2 (TOW)

5 BANGHAZ I, LIBYA 21.12.2019 14.01.2020 DISCHARGING 1 (ONE)

6 CONSTANTA , ROMANIA 07.12.2019 11.12.2019 LOADING 1 (one)

7 BEJAIA , ALGERIA 15.10.2019 25.10.2019 DISCHARGING 1 (ONE)

8 ROUEN , FRANCE 04.11.2019 04.11.2019 LOADING 1 (ONE)

9 LISBOA , PORTUGAL 25.10.2019 31.10.2019 DISCHARGING 1 (ONE)

10 CONSTANTA , ROMANIA 11.10.2019 15.10.2019 LOADING 1 (ONE)

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

12. Date and signature by master,authorized agent or officer

 MARITIME DECLARATION OF HEALTH
To be completed and submitted to the competent authorities by the masters of ships arrivining from foreign poets.

Submitted at the port of Date 01/03/2020

Name of ship or inland navigation vessel QUEEN LILA Registration/IMO no.: 9303376

Arriving from: MERSIN Sailing to:

(Nationality)(Flag of vessel): Belize Master's name: ABDULLATEEF OSAYLEE

Gross tonnage (ships): 19885 Tonnage (inland navigation vessels): N/A.

Valid Sanitation Exemption/Control Certifcate carried on boar Yes X NO

Issued at: GIBRALTAR Date : 3/1/2020 Re-inspection required? Yes No X

Has ship/vessel visited an affected area identified by World Health Organizatio Yes No X
List of ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorte

MERSIN

ALEXANDRIA

NYKOLAYEV

Number of crew member on board: 22

Number of passengers on board: Nil

Health Questions

1 Has any person died on board during the voyage otherwise than as a result of accident? No

If yes, state particulars in attached schedule. Total no. Of deaths:

2 Is there on board or has been during the international voyage any case of disease which you suspect to be of an

infection nature? If yes, state particulars unattached schedule. No

3 Has the total number of ill pasengers during the voyage been greater then normal/expected? No

How many ill persons:

4 Is there any ill person on board? If Yes state particulars in attached achedule. No

5 Was a medical practitioner consulted? If Yes, state particulars of medical treatment or advine provided No

6 Are you aware of any condition on board which may lead to infection or the spread of disease? No

If yes, state particulars in attached schedule.

7 Has a sanitary measure(e.g. quarantine, isolation, disinfection or decontamination) been applied on board No

If yes, specify type, place and date.

8 Have any stowaways been found on board? If yes, where did they join the ship(if known)? No

9 Is there a sick animal or pet on board? No

Note: In absence of a surgeon, the master should regard the following symptoms as ground for suspecting the existence of a

disease of an infections nature: a)fever, persisting for several days or accompanied by i) prostration, ii) decreased

consciousness, iii) glandular swelling, iv) jaundice, v) cough or shortness of breath, vi) unusual bleeding or vii) paralysis.

b) with or without fever, i) any skin rash or eruption, ii) severe vomiting (other than sea sickness), iii) severe diarhoea

or iv) recurrent convulsions.

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 beleief.

Signed:
Date: 01.03.2020 Master
SHIP'S PYROTECHNICS LIST Arrival ✘ Departure Page No. 1
1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure
QUEEN LILA UKRAINE.MYKOLAYIV 21.01.2020
4. Nationality of ship 5. Port OF DESTINATION 6. Date of departure
Belize
7. Description 8. Maker 9. Quantity 10. Place kept

LINE THROWING ROCKETS COMET PYROTECHNICS 4 PC BRIDGE

PARACHUTE ROCKETS COMET PYROTECHNICS 12 PC BRIDGE

HAND FLARES COMET PYROTECHNICS NIL BRIDGE

MOB SMOKE SIGNALS COMET PYROTECHNICS 2 PC BRIDGE WINGS

PARACHUTE ROCKETS COMET PYROTECHNICS 8 PC LIFE BOATS

HAND FLARES COMET PYROTECHNICS 12 PC LIFE BOATS

BUOYANT SMOKE SIGNALS COMET PYROTECHNICS 4 PC LIFE BOATS

ALL INFLATABLE LIFE RAFTS PYRO

TECHNICS AS DECLARED FROM LAST 3 LIFE RAFTS

INSPECTION RESPONSIBLE COMPANY

EXPIRED PYROTECHNICS

HAND FLARE 12 PC LOCKER

PARACHUTE ROCKETS 8 PC LOCKER

LIFE SMOKE SIGNAL 4 PC LOCKER

11. Date and signature by master,authorized agent or officer

MASTER: