DICHIARAZIONE GENERALE IMO GENERAL DECLARATION N/A

ALLEGATO A.2
DICHIARAZIONE GENERALE
IMO GENERAL DECLARATION
(IMO FAL Form 1)
X
Arrival
Departure
1.1 Nome e descrizione della nave - Name and type of ship
1.2 Numero IMO - IMO number
1.3 Nominativo Internazionale - Call sign
1.4 Numero del viaggio - Voyage number
2. Porto di arrivo/partenza - Port of arrival/departure
3. Data e ora di arrive/partenza - Date and time of
arrival/departure
4. Nazionalità della nave - Flag 5. Nome del Comandante - 6. Porto di provenienza/destinazione - Last port of call/Next
State of ship
Name of master
port of call
7. Certificato di iscrizione - Certificate of registry (Port; date; 8. Nome ed indirizzo dell’Agente marittimo - Name and
number)
contact details of ship’s agent
LUISE ASSOCIATES SICILY SRL
9. Stazza lorda - Gross tonnage
10. Stazza netta-Net tonnage
11. Posizione della nave in porto (ormeggio o ancoraggio) Position of the ship in the port (berth or station)
12. Breve descrizione del viaggio (scali precedent e successive; specificare dove verrà sbarcato il carico restante) - Brief
particulars of voyage (previous and subsequent ports of call; underline where remaining cargo will be discharged)
13. Breve descrizione del carico - Brief description of the cargo
NIL
14.
Numero di membri 15. Numero di passeggeri - 16. Osservazioni - Remarks
dell’equipaggio - Number of crew Number of passengers
Documenti allegati (indicare il numero delle copie) - Attached
documents
(indicate number of copies)
17. Dichiarazione di carico - Cargo
Declaration
N/A
19. Ruolo equipaggio - Crew List
18. Dichiarazione
delle provviste di
bordo - Ship’s Stores
Declaration YES
20. Elenco passeggeri 21. Esigenze della nave in materia di rifiuti e residui presso le
- Passenger List
reception facilities - The ship’s requirements in terms of waste
and residue reception facilities
22. Dichiarazione degli effetti personali 23. Dichiarazione di
dell’equipaggio - Crew’s Effects
Sanità Marittima Declaration (only on arrival)
Maritime Declaration
of Health (only on
arrival)
24. Data e firma del Comandante, agente o funzionario autorizzato - Date and signature by master, authorized agent or officer
IMO SHIP’S STORES DECLARATION
(IMO FAL Form 3)
Page Number
Arrival
Departure
1.1 Name of ship
1.2 IMO number
1.3 Call sign
1.4 Voyage number
2. Port of arrival/departure
3. Date of arrival/departure
4. Flag State of ship
5. Last port of call/Next port of call
6. Number of persons on board
7. Period of stay
8. Name of article
9. Quantity
10. Location on board
12. Date and signature by master, authorized agent or officer
11. Official use
IMO CREW’S EFFECTS DECLARATION
(IMO FAL Form 4)
Page Number
1.1 Name of ship
1.2 IMO number
1.3 Call sign
1.4 Voyage number
2. Flag State of ship
3. No.
4. Family name, given names
5. Rank or rating
8. Date and signature by master, authorized agent or officer
*
e.g., wines, spirits, cigarettes, tobacco, etc.
6. Effects ineligible for relief from
customs duties and taxes or subject to
prohibitions or restrictions*
7. Signature
IMO CREW LIST
(IMO FAL Form 5)
Page Number
Departure
Arrival
1.1 Name of ship
1.2 IMO number
1.3 Call sign
1.4 Voyage number
2. Port of arrival/departure
3. Date of arrival/departure
4. Flag State of ship
5. Last port of call
6. No. 7. Family name, given names
8. Rank or rating
12. Date and signature by master, authorized agent or officer
9. Nationality
10. Date and
place of birth
11. Nature and number of
identity document
IMO PASSENGER LIST
(IMO FAL Form 6)
Page Number
Arrival
1.1 Name of ship
1.2 IMO number
1.4 Voyage number
5. Family name, given names
2. Port of arrival/departure
6. Nationality
7. Date and place of birth
13. Date and signature by master, authorized agent or officer
1.3 Call sign
3. Date of arrival/departure
8. Type of identity or
travel document
Departure
9. Serial number of identity or
travel document
4. Flag State of ship
10. Port of
embarkation
11. Port of
disembarkation
12. Transit
passenger or not

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