Pre-arrival Procedure Format(Page1).docVIP

Pre-arrival Procedure Form（Page1） 【Unified Format for Captain of the Port, The Port Management Body, District Transport Bureau, and Japan Coast Guard office】 □Application to load/discharge dangerous goods □Application for berth assignment □Application for berth change □Application for moorings □Report on the Financial Security Information based on the Law on liability for Oil Pollution Damage □Report on the Security Information of Ships based on the Law for the Security of Ships and of Port Facilities You can use this form as a Report on the Security Information of Ship based on the Law for the Security of Ships and of Port Facilities , a Report on the Financial Security Information based on the Law on Liability for Oil Pollution Damage , and Application to load or discharge dangerous goods , for berth assignment , and for berth change under the Port Regulations Law , and as an Application for moorings 　 Captain of the Port □ 　　　　　The Port Management Body □ Director-General of the District Transport Bureau □ 　　　Chief of Coast Guard (office or station) □ Name of master Name of applicant Address of applicant Name of the person in charge/contact address Basic information Name of ship IMO number(or number of ship/fishing boat registration number） Type of ship 【 cargo vessel ? container vessel ? cargo passenger vessel ? passenger vessel ? oil tanker ? fishing vessel ? other 】　 【 S.S.　?　M.S.　?　sailing ship with engine　?　other 】 Flag state Port of registry Gross tonnage International gross tonnage Dead weight tonnage Length overall Communication system Call sign Other communication systems Owner, operator, and agent Ship’s owner Name Address TEL , FAX Ship’s operator (When the ship’s operator is different from the ship’s leaseholder, you should also include the ship’s leaseholder.） Name Address TEL , FAX Ship’s agent Name Address TEL , FAX Arrival information Port of arrival Expected date and time of arrival of the ship in port