Declaration of Security Completion Form

Captures the ship-port Declaration of Security completion details, confirming agreed security measures and responsibility during the ship-port interface.

Submission Notice

• Submitter Name
  Name of the person completing this form.
• Submitter Role
• I confirm the information provided is accurate and may be retained for compliance and audit trail purposes.

Vessel and Port Details

• Vessel Name
• IMO Number
  Enter only if needed for your compliance record.
• Port Facility Name
• Port Location
• Declaration of Security Reference Number
  Use if your organization assigns a DoS reference number.

Security Level and Effective Period

• Ship Security Level
• Port Facility Security Level
• Effective Date
• Effective Time
• Expected End Date

Agreed Security Measures

• Access Control Measures
• Cargo and Ship's Stores Controls
• Communication Procedures
• Additional Security Measures
  Describe any additional measures not covered above.

Responsibility and Sign-off

• Primary Responsible Party
• Ship Security Officer Name
• Port Facility Security Officer Name
• Signature Confirmation
  Provide an electronic signature or equivalent authorization.
• I confirm this Declaration of Security has been completed and the agreed measures are in effect.