A

SHIP’S NAME

FLAG

CALL SIGN

IMO NO

MMSI NO

B

DATE AND TIME (UTC)

C

REPORTING POSITION (LAT/LONG)

F

CONTINUOUS MANOEUVRING SPEED (in knots including decimals)

G

PORT OF DEPARTURE

H

DATE, TIME AND POINT OF ENTRY INTO VTS AREA (UTC)

I

PORT OF DESTINATION

J

REQUEST PILOT (YES/NO)

ISTANBUL STRAIT

MARMARA SEAİ

ÇANAKKALE STRAIT

O

FORWARD AND AFT DRAFT, MAX AIR DRAFT (AT THE ENRTRANCE)

AZAMİ HAVA ÇEKİMİ  (BOĞAZ GİRİŞİNDE)

P

CARGO (TYPE AND QUANTITY)

Q

DEFECTS/DAMAGE/DEFICIENCIES/OTHER LIMITATING REASONS

R

DESCRIPTION OF DANGEROUS, NUCLEER AND POLLUTANT GOODS

( UN NO / NAME / CLASS / QUANTITY )

T

SHIP’S AGENT/REPRESANTATIVE TAX NO

MARDAŞ MARMARA DNZ.İŞLT.A.Ş.

ULAŞTIRMA VD. 6120049788

U

SHIP TYPE

LOA / BEAM (METRES)

GRT/NRT

X

P&I INFORMATIOM

P&I CLUB NAME

POLICY NUMBER

VALIDITY

(X)

DETAILED INFORMATION FROM THE SHIP RELATED WITH HER CARGO

MAY BE REQUESTED FOR SAFETY CONSIDERATIONS.

(X)

BUNKER DETAILS ( IFO, MGO, LUBRICAN ) ON BOARD

(X)

CREW NUMBER ON BOARD

(X)

LST PSC EXPIRE DATE AND ISSUED PLACE