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Run: Declaration of Security Completion Form

Declaration of Security Completion Form for recording ship-port interface security measures, responsible parties, and sign-off in one place. Use it to docume...

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Submission Notice

Purpose of submission

I confirm the information provided is accurate and may be retained for compliance and audit trail purposes. (required)

Yes No N/A

Vessel and Port Identification

Vessel name (required)

IMO number

Enter the vessel's IMO number if available.

Port facility name (required)

Port location (required)

Date of ship-port interface (required)

Interface start time (required)

Interface end time

Security Levels and Applicable Measures

Ship security level (required)

Port facility security level (required)

Agreed security measures (required)

Other security measures

Primary party responsible for implementation (required)

Responsible Parties and Contacts

Ship security officer name (required)

Port security officer name (required)

Ship contact phone

Port contact phone

Primary contact email

Declaration and Sign-off

Declaration statement

Ship authorized signature (required)

Port authorized signature (required)

Date and time of completion (required)

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Email (required)

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