یکشنبه ۴ تیر ۱۳۹۶

  به روز رسانی :  1395/10/10    یوسف مرادپور

ADVANCE NOTIFICATION FORM-Page.1


NO:  PS-08-F04-02                     

The master of a ship should forward this form to the BIK port  authority directly or by ship agent at least 24 hours in advance of arrival or upon departure of the previous port if the voyage is less than 24 hours

Contact no: fax 06522522488

Email: oprc@bik.ir

DELIVERY FROM SHIPS (ANF)

1.  Ship Particulars

1.1  Name of ship:

1.5  Owner or operator:

1.2  IMO number:

1.6  Distinctive number or letters:

1.3  Gross tonnage:      

1.7  Flag State:

1.4  Type of ship:                               􀂅 Oil tanker             􀂅 Chemical tanker   􀂅 Bulk carrier       􀂅 Container

                        􀂅 Other cargo ship       􀂅 Passenger ship    􀂅 Ro-ro                      􀂅 Other (specify)

 

2.  Port and Voyage Particulars

 

2.1 Location/Terminal name and POC:

2.6 Last Port where waste was delivered:

2.2 Arrival Date and Time:

2.7 Date of

Last Delivery:

2.3 Departure Date and Time:

2.8 Next Port of delivery (if known):

2.4 Last Port and Country:

2.9 Person submitting this form is (if other than the master):

 

 

2.5 Next Port and Country (if known):

3.  Type and Amount of Waste for Discharge to Facility

MARPOL Annex I – Oil

Quantity (m3)

Oily bilge water

 

Oily residues (sludge)

 

Oily tank washings

 

Dirty ballast water

 

Scale and sludge from tank cleaning

 

Other (please specify)

 

MARPOL Annex II – NLS

Quantity (m3)/Name

Category X substance

 

Category Y substance

 

Category Z substance

 

OS – other substances

 

MARPOL Annex IV – Sewage

Quantity (m3)

 

 

 

MARPOL Annex V – Garbage

Quantity (m3)

A. Plastic

 

B. Food wastes

 

C. Domestic wastes (e.g. paper products,rags,glass,metal.bottles,crocckery.etc)

 

D. Cooking oil

 

E. Incinerator ashes

 

F. Operational wastes

 

G. Cargo residues2

 

H. Animal carcass(es)

 

I. Fishing gear

 

MARPOL Annex VI – related

Quantity (m3)

Ozone-depleting substances and equipment containing such substances

 

Exhaust gas-cleaning residues

 

 

 

 

1          indicate the proper shipping name of the NLS involved                                             2      indicate the proper shipping name of the dry cargo

 

 

 

 

 

 

 

 

 

ADVANCE NOTIFICATION FORM-Page.2

               

Name of ship:                                                 IMO Number:

 

Please state below the approximate amount of waste and residues remaining on board and the percentage of maximum storage capacity.  If delivering all waste on board at this port please strike through this table and tick the box below.  If delivering some or no waste, please complete all columns.

I confirm that I am delivering all the waste held on board this vessel (as shown on page 1) at this port

 

Type

Maximum dedicated storage capacity m3

Amount of waste retained on board m3

Port at which remaining waste will be delivered (if known)

Estimate amount of waste to be generated between notification and next port of call m3

MARPOL Annex I – Oil

Oily bilge water

 

 

 

 

Oily residues (sludge)

 

 

 

 

Oily tank washings

 

 

 

 

Dirty ballast water

 

 

 

 

Scale and sludge from tank cleaning

 

 

 

 

Other (please specify)

 

 

 

 

MARPOL Annex II – NLS3

Category X substance

 

 

 

 

Category Y substance

 

 

 

 

Category Z substance

 

 

 

 

OS – other substances

 

 

 

 

MARPOL Annex IV – Sewage

Sewage

 

 

 

 

MARPOL Annex V – Garbage

A. Plastic

 

 

 

 

B. Food wastes

 

 

 

 

C. Domestic wastes (e.g. paper products , rags,glass, metal.bottles, crocckery.etc)

 

 

 

 

D. Cooking oil

 

 

 

 

E. Incinerator ashes

 

 

 

 

F. Operational wastes

 

 

 

 

G. Cargo residues4

 

 

 

 

H. Animal carcass(es)

 

 

 

 

I. Fishing gear

 

 

 

 

 

Date: ......................................................                 Name and Position: ................................................................................................

Time: .....................................................                 Signature: ...............................................................................................................