ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

ADDITIONAL INFORMATION OF ARRIVAL

INSTRUCTIONS
1. We recommend saving this file as a master copy if you will be submitting information frequently. a)Click File, then click Save. b)You will be prompted to give the document a name (as "IAA") and choose a place to save it. 2. Then you can fill out this spreadsheet each time you need to send us this information. a)Double-clicking on the icon representing the file you saved. b)The file will open and you can simply enter the information required. Once you have completed filling out the first page, you can move on to the rest of the spreadsheet by using the small gray tabs at the bottom of the window. 3. Once you have completed filling in the required information, save it by clicking File / Save As. 4. You will be prompted to give the document a different name (may be IAA and the name of your vessel) and choose a place to save it. 5. There are several ways to email the form back to us this format. a)You can select File / Send To | Mail Recipient (as attachment), which will open your email program with the file already attached. You then just put our address, guayaquil_radio@dirnea.org in the" To": line, and send it off. b)Too you can close the spreadsheet program, open your email program, address a new message to guayaquil_radio@dirnea.org, then attach the file you just saved to the message, and send it off. . 6.This interactive workbook uses excel "Comments", which flags cells that have a comment dialog hidden within the cell. Simply place the cursor over a red flag displayed in the upper right corner of the cell. The dialog box that appears has helpful information regarding information required in that field. 7. Before emailing the information, please check to ensure all required fields are filled in to avoid any delay in processing and subsequent delay of the vessel. 8. If you are a shipping agent, you can have your clients fill out the spreadsheet on the ship and then have them send you a copy, this may save you from having to forward the information. 9. If you are submitting for several different vessels frequently, try making a master copy for each ship. After filling out the information the first time, save that file using the ships name. You can then go back into that file for the next required and simply edit the information that has changed. 10. In case that a ship doesn't have the available means to send this information by email, it may send it through by its Shipping Agency, 72 hours before its arrival to the destination port.

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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ADDITIONAL INFORMATION OF ARRIVAL

1. GENERAL INFORMATION OF VESSEL
Vessel Name Call Sign Ship Register (Flag)

FORMATO IAA

IMO Number

Type of Ship

Year of Build

Port of Registry

Date of Registry

Lenght overall (LOA)

Lenght b. Per (LPP) Operator / Charterer

Lenght (*)

Gross Tonnage

Net Tonnage

Deadweit

Breadth

Depth

Draught

Shipowner

Classification Society

Security Level

2. INTERNATIONAL SHIP SECURITY CERTIFICATE

Date of Issuance Type of Certificate Vessel Security Plan implemented

Approved Change of Owner/Operator

Interim

Final Transfer of vessel's flag

Yes

No

Indicate reason if the certificate is Interim

Flag Administration or RSO

New to/re-entry into service

2.1 SECURITY MARITIME OFFICERS

SSO Name Position or Duties on board Email Address

CSO Name

Telephone Number - 24 Hour

Email Address

Reporting Party Name

Reporting Company / Shipping Agency

Telephone Number and/or Email Addres

3. VOYAGE INFORMATION
Destination Port or Place/City Estimated Date & Time of Arrival Estimated Date & Time of Departure

Destination Receiving Facility/Terminal/Anchorage

Captain of Port Office/Superintendencia involved

Point of Contact on Port - 24 hour (Shipping Agency and Agent)

Telephon Number

Email Address

3.1 LAST TEN PORTS

Port Date of Arrival Date of Departure Security Level Additional Measures Procedures Ship to Ship

3.2 CARGO
General Description of Cargo Cargo Amount Dangerous Cargo on board

Yes

No

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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OMI GENERAL DECLARATION

Onwer 1. Name and type of ship 1.2 OMI Number 1.3 Call sign 4. Flag State of ship

FORMATO OMI FAL 1

Arrival Departure 2. Port of arrival / departure 3. Date time of arrival departure. 5. Name of master 6. Last port call / Next port of call 8. Name and contact detail of ships agent

7. Certificate of registry ( Port date number) 9. Gross tonnage 10. Net tonnage

11. Position of the ship in the port (berth or terminal) 12.Brief particulars of voyage (previous/subsequent ports of call; underline where remaining cargo will be discharge

13. Brief description of the cargo. 14. Number of crew (incl. master) 15. Number of passangers 16. Remarks Attached documents (indicate number of copies) 17. Cargo Declaration 18. Ships Stores Declara YES YES 19. Crew list 20. Passenger List 21. The ships requirements in term of waste and residue YES YES reception fecilities. 22. Crew Effects Declarations3 Maritime Declaration. 2 YES of Health. * YES 24. Date and signature by master, authorizad agent or officer.

* A la llegada solamente

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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OMI SHIPS STORES DECLARATION

FORMATO OMI FAL 3

Page No. Arrival 1. Name and type of ship 1.2 OMI Number 1.3 Call sign 4. Flag State of ship
6.Nomber of persons onboard 7. Period of stay

Departure 2. Port of arrival / departure

3. Date of arrival/deparute

5. Last port of call / Next port call 8. Place of storage

9. Name of article

10.Qua 11. Official use tity

12. Date and signature by master, authorizad agent or officer

ted the information it may

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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OMI CREWS EFFECTS DECLARATION

FORMATO OMI FAL 4

Page No 1. Name and type of ship 1.2 OMI Number 1.3 Call sign 3. Flag State of ship 4.No 5 Family name, given names 6. Rank or rating 2 Effects ineligible for relief from customs duties and taxes or subject prohibitions or restrictions*

7. Signature

08. Date and signature by master, authorizad agent or officer

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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OMI CREW LIST

FORMATO OMI FAL 5

Arrival 1. Name and type of ship 1.2 OMI Number 1.3 Call sign 4. Flag State of ship 7. No 8. Family name, given names
9. Rank or rating 2. Port of arrival / departure

Departure 3. Date time of arrival departure.

5. Last port call 10. Nationality 11. Date and place of birth

6.Nature and No. Of identity document (seamans book and passport)

12. Date and signature by master, authorizad agent or officer

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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PASSENGERS LIST
FORMATO OMI FAL 6

Arrival 1.1 1.2 1.3 4. 5. Name and type of ship OMI Number Call sign Flag State of Ship Full Name and 6.Nacionality 7. Date and Place of Birth 8. 2.

Departure 3. Date of Arrival / Departure

Page Number

Port of Arrival / Departure

Type of identity document

9. Serial Number 10. ID

Port of Embarkation

11. Port of disembarkation

12. Pasenger Trafic Yes/No

10.

Date and signature by master, authorizad agent or officer.

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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FORMATO OMI FAL 7

DANGEROUS GOODS MANIFEST

(AS REQUIRED BY SOLAS 74. CHAPTER VII, REGULATIONS 4.5. AND 7-2.2. MARPOL 73/78. ANNEX III. REGULATION 4.3. AND CHAPTER 5.4. PARAGRAPH 5.4.3.1 OF THE IMDG CODE)
PAGE NUMBER

1.1. NAME OF SHIP

1.2 IMO NUMBER

1.3 CALL SIGN

1.4 5.

VOYAGE NUMBER BOOKING / 6. REFERENCE NUMBER MARK & NUMBERS CONTAINE R ID NO.(s) VEHICLE REG. NO. (s)

2. FLAG STATE OF SHIP 7. NUMBERS 8. PROPER AND KIND SHIPPING OF NAME PACKAGES 9. CLASS

3. 10. ONU No. 11.

PORT OF LOADING PACKING 12. SUBSIDIARY GROUP RISK (s)

4. PORT. OF DISCHARGE 13. FLASHPOINT 14. MARINE 15. MASS (KG) 16. EmS (in C.c.c.) POLLUTANT GROSS/NET 17 STOWAGE POSITION ON BOARD

ADDITIONAL INFORMATION

18.1 NAME OF MASTER 18.2 PLACE AND DATE SIGNATURE OF MASTER

19.1SHIPPING AGENT 19.2PLACE AND DATE 19.3SIGNATURE OF AGENT

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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MEASURES AND PROCEDURES

ADDITIONAL MEASURES
Port Additional Measures

PROCEDURES SHIP TO SHIP

Port Security Procedures Ship to Ship

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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MARITIME DECLARATION OF HEALTH

To be completed and sumitted yto the competent authorities by the masters of ships arriving from foreing ports. Submitted at the port of . .. Date Name of ship or inland navigation vessel ............ Registration/IMO No ...................arriving from ...sailing to ............... (Nationality)(Flag of vessel) . Masters name .............................................................................................. Gross tonnage (ship) .. Tonnage (inland navigation vessel) Valid Sanitation Control Exemption/Control Certificate carried on board? Yes ............ No ......... Issued at ....... date .......... Re-inspection required? Yes . No . Has ship/vessel visited an affected area identified by the World Health Organization? Yes ..... No .. Port and date of visit .......................... List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter:
.........................................................................................................................................................................................................................

Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined ship/vessel since international voyage began or within past thirty days, whichever is shorter, including all ports/countries visited in this period (add additional names to the attached schedule): (1) Name joined from: (1) ........(2) ..........(3) ......................................... (2) Name joined from: (1) ........(2) ..........(3) ......................................... (3) Name .joined from: (1) ........(2) ..........(3) ........................................ Number of crew members on board Number of passengers on board .

HEALTH QUESTIONS 1. 2. 3. 4. 5. 6. 7. 8. 9.
Has any person died on board during the voyage otherwise than as a result of accident? If yes, state particulars in attached schedule. Total no. of deaths .......... Is there on board or has there been during the internatinal voyage any case of disease which you suspect to be of an infectious nature? If yes, state particulars in attached schedule. Has the total number of ill passengers during the voyage been greater than normal/expected? How many ill persons? .......... Is there any ill person on board now ? If yes, state particulars in attached schedule Was a medical practitioner consulted? If yes, state particulars of medical treatment or advice provided in attached Are you aware of any condition on board which may lead to infection or spread of disease? If yes, state particulars in attached schedule. Has any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board? Have any stowaways been found on board? If yes, where did they join the ship (if known)?

Answer

Yes

or

No

Is there a sick animal or pet on board? Note: In the absence of a surgeon, the master should regard the following symptoms as grounds for suspecting the existence of a disease of an infectious nature: a) fever, persisting for several days or accompanied by (i) prostration; (ii) decreased consciousness; (iii) glandular swelling;(iv) jaundice; (v) cough or shortness of breath; (vi) unusual bleeding; or (vii) paralysis. convulsions. I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief.

b) with or without fever: (i) any acute skin rash or eruption; (ii) severe vomiting (other than sea sickness); (iii) severediarrhoea; or (iv) recurrent

SIGNED Master COUNTERSIGNED Ship's Surgeon Date :

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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ATTACHMENT TO MODEL OF MARITIME DECLARATION OF HEALTH

PORT, DATE JOINED SHIP/VESSEL DATE OF ONSET OF SYMPTOMS REPORTED TO A PORT MEDICAL OFFICER? DRUGS, MEDICINES OR OTHER TREATMENT GIVEN TO PATIENT

NAME

CLASS OR RATTING

AGE

SEX

NATIONALITY

NATURE OF ILLNESS

DISPOSAL OF CASE

COMMENTS

State:

1) Whether the person recovered, is still ill, or died; and 2) whether the person is still on board, was evacuated (including the name of the port or airport) or was buried at sea.

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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OMI CREW VACCINATION LIST

NAME RANK DATE VACCINATED EXPIRY DATE

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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NIL LIST
1. Name and type of ship 1.2 OMI Number 1.3 Call sign

DATE:

ARMS AND AMMUNITION NARCOTICS PARCEL MAIL PASSENGER STOWAWAY THRU CARGO BIRDS OR ANIMALS

MASTER:

ECUADOR - FUERZA NAVAL DIRECCION NACIONAL DE ESPACIOS ACUATICOS

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MAIL WAY BILL

1. Name and type of ship 1.2 OMI Number 1.3 Call sign
NUMBRES OF SACKS ORIGEN DESTINATION REGISTERED LETTERS & PRINS PARCEL POST EMPTY SACKS WEIGHT KILOS

DATE:

TOTALS

POST OFFICE CLERK

RECEIVED ON BOARD AS LISTED

SHIPS MAIL OFFICER