Declaration of Security Completion Form

Captures ship-port Declaration of Security completion details, including the parties, security responsibilities, agreed measures, and signatures for the ship-port interface.

Submission Notice

• Purpose of submission
• I confirm the information provided is accurate and may be retained for compliance and audit trail purposes.

Vessel and Port Identification

• Vessel name
• IMO number
  Enter the vessel's IMO number if available.
• Port facility name
• Port location
• Date of ship-port interface
• Interface start time
• Interface end time

Security Levels and Applicable Measures

• Ship security level
• Port facility security level
• Agreed security measures
• Other security measures
• Primary party responsible for implementation

Responsible Parties and Contacts

• Ship security officer name
• Port security officer name
• Ship contact phone
• Port contact phone
• Primary contact email

Declaration and Sign-off

• Declaration statement
• Ship authorized signature
• Port authorized signature
• Date and time of completion