CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
----------------------

THNG BO TU N CNG (QU CNH)

NOTICE OF ARRIVAL OF VESSEL AT THE PORT (TRANSIT)

Tn v loi tu:
Name and type of ship
S IMO:
IMO number
H hiu:
Call sign
Quc tch tu
Tn thuyn trng
Flag State of ship
Name of master
Giy chng nhn ng k (S, ngy cp,
cng)
Certificate of registry (Number, date of
issue, and Port)
Chiu di ln nht
Chiu rng
LOA
Breadth
Tng dung tch
GT

Trng ti ton phn

DWT

Cng n
Port of arrival

Thi gian n
Time of arrival

Cng ri cui cng/cng ch:

Last port of call/port of destination
Tn v a ch ca ch tu
Name and address of the shipowners
Chiu cao tnh
Mn nc thc t
khng
Shown draft
Clearance height
i l ca ch tu ti Vit Nam (nu c)
Name of the shipowners agents in Viet Nam
(if any)

Mc ch n cng (Qu cnh i)

Purpose of call (Transit to)
S lng v loi hng ha vn chuyn trn tu
Quantity and types of cargoes on board
S thuyn vin
S hnh khch
Ghi ch:
(gm c thuyn
Number of
Remarks
trng):
passengers
Number of crew
(incl. Master)
Nhng ngi khc trn tu
Other persons on board
, ngy thng nm 20
Date ......................................
Thuyn trng (hoc i l)
Master (or authorized agent)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

BN KHAI AN NINH TU BIN

SHIPS SECURITY NOTIFICATION

1. Tn tu:
2. Quc tch tu
3. H hiu
Name of Ship
Flag State of ship
Call-Sign
4. Tng dung tch
5. Loi tu:
6. S lng thuyn vin:
Gross tonnage
Type of Ship
No.of Crew
7. Thi gian d kin n cng:
8. S IMO:
ETA:
IMO No.
9. Mc ch n cng: Bc/D/Tip nhin liu/Sa cha/Mc ch khc (gch b t
thch hp)
Purpose of Call: Loading / Discharging / Bunkering / Shipyard / Others (Delete as
appropriate)
Nu l mc ch khc nu r:
If others, please specify purpose:
10. Tn khu vc neo u hoc cu cng m tu s n:
Name of Anchorage or Port Factility your ship in bound for:
11. Tn i l tu bin ti Vit Nam:
Name of Ship Agent in Vietnam:
Tel No:
Fax No:
12. Tu c GCN quc t v an ninh tu bin (ISSC) khng?
Does your ship possess a valid International Ship Security Certificate (ISSC)?
C/Khng (gch b t thch hp)
Yes/No (Delete as appropriate)
Nu cu tr li l C th nu chi tit ti cc cu hi 13, 14
If answer if Yes, give details in Q13 and Q14.
13. Tn c quan cp ISSC
Name of issuing authority for the ISSC
14. Ngy cp ISSC
15. Ngy ISSC ht hn:
Date of issue of the ISSC
Date of expiry of the ISSC
16. Cp an ninh hin ti ca tu:
Current security level of the ship
17. Mi cng m tu gh vo gn nht, ngy n, ngy i v cp an ninh tu
p dng khi thc hin giao tip gia tu bin v cng bin:

Last 10 ports of call, including arrival / departure dates and the security level at which
the ship operated at these ports where it has conducted a ship / port interface
Cng
Ngy n
Ngy i
Cp an ninh
Port
Arrival
Departure
Security Level

18. Trong thi gian thc hin bt k giao tip gia tu bin v cng bin c cp ti
cu hi 17 trn y, tu bin c p dng bin php an ninh c bit hoc bin php an
ninh b sung no khng?
Were there any special or additional security measures taken during any ship/port
interface at the ports mentioned in Q17?
C/Khng (gch b t thch hp)
Yes/No (Delete as appropriate)
Nu cu tr li l C th nu chi tit:
If answer is Yes, give detail:
19. Trong thi gian thc hin bt k giao tip gia tu bin v tu bin c cp ti
cu hi 17 trn y, tu bin c duy tr bin php an ninh thch hp khng?
Were there appropriate ship security measures maintained during any ship-to-ship
activity interface at the ports mentioned in Q17?
C/Khng (gch b t thch hp)
Yes/No (Delete as appropriate)
Nu cu tr li l C th nu chi tit:
If answer is Yes, give detail:
Ch k ca Thuyn trng/Ch tu/i
l tu:
Signature of Master/Shipowner/Agent
H tn ca Thuyn trng/Ch tu/i
l tu:
Name of master/Shipowner/Agent
V tr hin ti: V .; Kinh :

Present position: Latitude

Longitude

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

BN KHAI CHUNG
GENERAL DECLARATION

n
Arrival
2. Cng n/ri
Port of
arrival/departure

Ri
Departure
3. Thi gian n/ri
cng
Date - time of
arrival/departure

1.1 Tn v loi tu:

Name and type of ship:
1.2 S IMO:
IMO number:
1.3 H hiu:
Call sign:
1.4 S chuyn i:
Voyage number:
4. Quc tch tu
5. Tn thuyn
6. Cng ri cui cng/cng ch:
Flag State of ship
trng
Last port of call/next port of call
Name of master
7. Giy chng nhn ng k (S, ngy 8. Tn v a ch lin lc ca i l:
cp, cng)
Name and contact details of the ship agent
Certificate of registry (Port, date;
number)
9. Tng dung tch 10. Dung tch c
Gross tonnage
ch
Net tonnage
11. V tr tu ti cng:
Position of the ship in the port (berth
or station)
12. c im chnh ca chuyn i (cc cng trc v cc cng s n, gch chn cc
cng s d hng) s hng cn li
Brief particulars of voyage (previous and subsequent port of call; underline where
remaining cargo will be discharged)
13. M t tm tt v hng ha
Brief description of the cargo
14. S thuyn
15. S hnh khch 16. Ghi ch:
vin (gm c
Number of
Remarks
thuyn trng)
passenger
Number of crew
(inl. master)

Ti liu nh km (ghi r s bn)

Attached documents (indicate number
of copies)
17. Bn khai hng
18. Bn khai d
ha:
tr ca tu
Cargo
Ships Stores
Declaration
Declaration
19. Danh sch
20. Danh sch
thuyn vin
hnh khch
Crew List
Passenger List
22. Bn khai hnh 23. Bn khai kim
l thuyn vin(*)
dch y t(*)
Crews Effects
Maritime
Declaration(*)
Declaration of
Health(*)

21. Yu cu v phng tin tip nhn v x l

cht thi
The ships requirements in terms of waste and
residue receptions facilities

24. , ngy thng nm 20

Date ...........
Thuyn trng (i l hoc s quan c y
quyn)
Master (or authorized agent or officer)
(*) Mc ny ch khai khi tu n cng
only on arrival

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

DANH SCH THUYN VIN

CREW LIST

1.1 Tn tu:
Name of ship
1.2 S IMO:
IMO number
4. Quc tch tu:
Flag State of ship
6.
7. H v tn
STT
Family name,
No.
given name

n
Ri
Trang s:
Arrival
Departure
Page No:
2. Cng n/ri:
3. Ngy n/ri:
Port of arrival/departure
Date of arrival/departure
1.3 H hiu:
1.4 S chuyn i:
Call sign
Voyage number
5. Cng ri cui cng:
Last port of call
8.
9. Quc tch 10. Ngy v
11. Loi v S H
Chc
Nationality
ni sinh
chiu
danh
Date and
Nature and No. of
Rank
place of birth
identity
of
documents
rating
(seamans
passport)

.., ngy thng . nm 20

Date................................
Thuyn trng (i l hoc s quan c y quyn)
Master (Authorized agent or officer)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

DANH SCH HNH KHCH

PASSENGER LIST

n
Arrival
2. Cng n/ri:
Port of arrival/departure
1.3 H hiu:
Call sign

1.1 Tn tu:
Name of ship
1.2 S IMO:
IMO number
4. Quc tch
tu:
Flag State of
ship
5. H v
6. Quc tch
tn
Nationality
Family
name,
given
name

7. Ngy
v ni
sinh
Date
and
place of
birth

8. Loi H
chiu
Type of
identity or
travel
document

Ri
Departure
3. Ngy n/ri:
Date of arrival/departure
1.4 S chuyn i:
Voyage number

9. S h chiu
Serial number
of identity or
travel
document

10. Cng ln tu
Port of
embarkation

Trang s:
Page No:

11. Cng ri tu
Port of
disembarkation

12. Hnh
khch qu
cnh hay
khng
Transit
passenger or
not

.., ngy thng . nm 20

Date....................
Thuyn trng (i l hoc s quan c y quyn)
Master (Authorized agent or officer)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

BN KHAI HNG HA
CARGO DECLARATION

1.1 Tn tu
Name of ship
1.2 S IMO:
IMO number
1.3 H hiu:
Call sign
1.4 S chuyn i:
Voyage number
3. Quc tch
4. Tn thuyn trng:
tu:
Name of master
Flag State of
ship
V 6. K hiu v s
7. S v loi bao
n
hiu hng ha
kin; loi hng ha,
Marks and Nos.
m hng ha
n
Number and kind of
s*
packages; description
B/
of goods, or, if
L
available, the HS
No
code

n
Ri
Arrival
Departure
2. Cng lp bn khai:
Port where report is made

Trang s:
Page No:

5. Cng bc/d hng ha:

Port of loading/Port of discharge
8. Tng trng
lng
Gross weight

9. Kch thc
Measurement

* S Vn n: Khai cng nhn hng chnh thc theo phng thc vn ti a phng thc hoc vn n sut.
B/L No: Also state original port by shipment using multimodal transport document or through Bill of Lading

.., ngy thng . nm 20

Date..............................
Thuyn trng (i l hoc s quan c y quyn)
Master (Authorized agent or officer)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
-----------------------

BN KHAI HNG HA NGUY HIM

DANGEROUS GOODS MANIFEST

1.1 Tn tu
Name of ship
1.3 H hiu
Call sign
1.4 S chuyn i:
Voyage number
5. Hp
6. K
ng vn hiu v s
chuyn
kin
hng ha Marks &
v m s numbers
tham
container
chiu
Id.
Booking/
NO(s)
reference
Vehicle
number
Reg.
No(s).

1.2 S IMO
IMO Number
3. Cng nhn hng
Port of loading
7. S v
loi bao
kin
Number
and kind
of
packages

Thng tin b sung:

Additional Information
19.1 i l k
Agents signature
19.2 a im v thi gian
Place and Date

8. Cty
vn
chuyn
Proper
shipping
name

9.
Loi
hng
ha
Class

2. Quc tch tu
Flag state of ship
4. Cng tr hng
Port of discharge
10. S
UN
UN
number

11.
Nhm
hng
Packing
group

12. Nhm
ph s
Subsidiary
risk(s)

1.5 Tn thuyn trng:

Masters Name
1.6 i l tu bin:
Shipping Agent
13.
im
bc
chy
Flash
point
(In
oC,
c.c.)

18.1 Thuyn trng k

Masters signature
18.2 a im v thi gian
Place and Date

14.
nhim
bin
Marine
pollutant

15. Tng
khi lng
Mass (kg)
Gross/Net

16.
EmS

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

BN KHAI D TR CA TU
SHIPS STORES DECLARATION

1.1 Tn tu:
Name of ship
1.2 S IMO:
IMO number
1.3 H hiu:
Call sign
1.4 S chuyn i:
Voyage number
4. Quc tch tu:
Nationality of ship
6. S ngi
7. Thi gian
trn tu
cng
Number of
Period of stay
person on
board
8. Tn vt
9. S lng
phm
Quantity
Name of
article

n
Arrival
2. Cng n/ri:
Port of
arrival/departure

Ri
Trang s:
Departure
Page No:
3. Ngy n/ri:
Date of arrival/departure

5. Cng ri cui cng/cng ch:

Last port of call/Next port of call

10. V tr tn tu
Location on board

11. S dng trn tu

Official use

.., ngy thng . nm 20

Date.
Thuyn trng (i l hoc s quan c y quyn)
Master (Authorized agent or officer)

NG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

BN KHAI HNH L THUYN VIN

CREWS EFFECTS DECLARATION

Trang s:
Page No:
1.1 Tn tu:
Name of ship
1.2 S IMO:
IMO number
1.3 H hiu:
Call sign
1.4 S chuyn i:
Voyage number
2. Quc tch tu:
Flag State of ship
3.
4. H v tn
TT
Family name,
No.
given name

5. Chc danh
Rank or rating

6. Hnh l phi np thu, b

cm hoc hn ch (*)
Effects ineligible for relief
from customs duties and
taxes or subject to
prohibitions or restrictions
(*)

7. Ch k
Signature

(*) V d: Ru, cn, thuc l bao, thuc l si v.v

e.g. wines, spirits, cigarettes, tobaco, etc

..., ngy thng nm 20

Date...................
Thuyn trng (i l hoc s quan c y quyn)
Master (Authorized agent or officer)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
--------------GIY KHAI BO Y T HNG HI
MODEL OF MARITIME DECLARATION OF HEALTH
Thuyn trng ca tu n t cc cng ngoi nc phi hon chnh t khai v xut trnh cho c quan thm
quyn/To be completed and submitted to be competent authorities by the master of ships arriving from foreign ports.
Xut trnh ti cng/Submitted at the port of .. Ngy/Date ..
Tn tu thy/Name of ship or inland navigation vessel ..
ng k/S IMO/Registration/IMO No
n t/Arriving from . Ni n/Sailing to
Quc tch (c quc tch)/Nationality (Flags of vessel) .
Thuyn trng/Masters name .
Trng ti ng k (tu)/Gross tonnage (ship)
Trng ti tu (tu thy chy trong ni a)/Tonnage inland navigation vessel)
Giy chng nhn min x l v sinh/X l v sinh cn gi tr?/Valid Sanitation Control Exemption/Control
Certificate carried on board?
C/Yes Khng/No
Cp ti/Issued at .. Ngy thng/Date .
C phi kim tra li hay khng?/Re-inspection required?
C/Yes Khng/No
C n vng T chc y t th gii khng nh nh hng?/Has ship/vessel visited an affected are identified by
the World Health Organization?
C/Yes Khng/No
Tn cng v ngy n/Port and date of visit ..
Danh sch cc cng t khi tu bt u hnh trnh, c ngy thng xut pht, hoc trong vng 30 ngy qua, nu
tm tt/List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is
shorter

Ty theo yu cu ca c quan thm quyn ti cng n, lp danh sch thy th, hnh khch hoc ngi cng i
trn tu k t khi bt u hnh trnh hoc trong 30 ngy tr li (nu tm tt), ghi r tn nc, tn cng i qua (km
theo h tn v lch trnh)/Upon the 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 in
shorter, including all ports/countries visited in this period (add additional names to the attached schedules)

1. H tn/Name ln tu t/joined from: (1) (2) . (3)

2. H tn/Name ln tu t/joined from: (1) (2) . (3)
3. H tn/Name ln tu t/joined from: (1) (2) . (3)
S thy thy trn tu/Number of crew members on board ..
S hnh khch trn tu/Number of passengers on board

CC CU HI V Y T
Health Questions

1. C ngi cht khng phi do tai nn trong hnh trnh?/Has an person died on board during the voyage
otherwise than as a result of accident?
C/Yes Khng/No
Nu c, phi c bo co chi tit km theo/If yes, state particulars in attached schedule/S t vong/Total of deaths/
..
2. C trng hp nghi mc bnh truyn nhim trn tu hoc trong qu trnh hnh trnh hay khng?/Is there on
board has there been during the international voyage any case of disease which you suspect to be of an infectious
nature?
C/Yes Khng/No
Nu c, phi c bo co chi tit theo mu km theo/If yes, state particulars in attached schedule
3. C s hnh khch b m trong hnh trnh ln hn bnh thng khng?/Has the total number of ill passengers
during the voyage been greater than normal/expected?
C/Yes Khng/No
Bao nhiu ngi?/How many ill person?..............................................................
4. Hin ti c ngi m trn tu khng?/Is there any ill person on board now?
C/Yes Khng/No
Nu c, bo co chi tit theo mu km theo/If yes, state particulars in attached schedule
5. C c nhn vin y t can thip khng?/Was a medical practitioner consulted?
C/Yes Khng/No
Nu c, nu chi tit bin php iu tr hoc t vn y t km theo/If yes, state particulars of medical treatment or
advice provided in attached schedule.
6. Bn c bit iu g c th gy nhim hoc lan truyn bnh trn tu khng?/Are you aware of any condition on
board which may lead to infection or spread of disease?
C/Yes Khng/No
Nu c, phi c bo co chi tit theo mu km theo/If yes, state particulars in attached schedule

7. C bin php v sinh no (nh kim dch, cch ly, ty trng hoc ty u) c p dng trn tu khng?/ Has
any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board?
C/Yes Khng/No
Nu c, nu c th loi, ni v thi gian p dng/If yes, specify type, place and date ..
8. C ngi i lu v trn tu khng?/Have any stowaways been from on board?
C/Yes Khng/No
Nu c, ni h ln tu u (nu bit)?/If yes, where did they join the ship (if know)?
.
9. C ng vt b m hoc ng vt cnh trn tu khng?/Is there a sick animal or pet on board?
C/Yes Khng/No
Ch : Nu khng c bc s, ch tu cn ch nhng triu chng hoc c du hiu mc bnh truyn nhim trn
tu nh sau: Note: In the absence of surgeon, the master should regard the following symptoms as ground for suspecting
the existence or a disease of an infectious nature:
(a) st ko di mt vi ngy hoc km theo (i) mt mi, (ii) km tnh to; (iii) ni hch; (iv) vng da; (v) ho hoc
th nng; (vi) chy mu bt thng hoc; (vii) lit cc b/(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
(b) c hoc khng c st: (i) pht ban cp tnh trn da; (ii) nn d di (khng phi do say sng); (iii) a chy d
di; hoc (iv) co git/(b) with or without fever: (i) any acute skin rash or eruption, (ii) severe vomiting (other than see
sickness), (iii) severe diarrhoea; or (iv) recurrent convulsions.
Ti xin cam oan nhng thng tin, nhng cu tr li v cc bo co chi tit km theo l s tht v ng vi s
hiu bit v tin tng ca ti/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
K tn/ Signed/
Thuyn trng/Master
K xc nhn/Countersigned ..
Bc s trn tu (nu c)/Ships Surgeon (if carried) ..
Ngy thng/Date .

MU T KHAI Y T HNG HI NH KM
ATTACHMENT TO MODEL OF MARITIME DECLARATION OF HEALTH

H tn/ i Tui/ Gii Quc Tn cng Chn on/ Ngy xut thng bo cho Kt qu x Thuc hoc iu tr
Ghi ch/
Name tng/ Age tnh/ tch/ v ngy Nature of hin triu
y t cng/
l1/of case2
khc p dng/
Comments
Class or
Sex Nation ln tu/
illness chng/ Date Reported to a port
Drugs, medicines or
rating
ality Port, date
of onset of medical officer?
other treatment given
joined
symptoms
to patient
ship/vessel

____________

1 Ngi bnh bnh phc, cn m hoc cht/whether the person recovered, is still ill or died.
2 Ngi bnh vn trn tu hay xung (ghi r tn cng hoc sn bay xung) hoc c an tng trn bin/State/whether the person is still on
board, was evacuated (including the name of the port or airport) or was buried at sea.

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
--------------BN KHAI KIM DCH THC VT
DECLARATION FOR PLANT QUARANTINE

Tn tu:

Name of ship
Tn thuyn trng:

Name of master
S thuyn vin:
...
Number of crew
Cng ri cui cng:

Last port of call

Quc tch tu:

..
Flag State of ship
Tn bc s:
..
Name of doctor
S hnh khch:
..
Number of passengers
Cng n tip theo:

Next port of call

Cng bc hng u tin v ngy ri cng :

The list port of loading and the date of departure: .
Tn, s lng, khi lng hng thc vt nhn cng u tin:
Name, quantity and weight of plant goods loaded at the first port:

Tn, s lng, khi lng hng thc vt nhn cc cng trung gian v tn cc cng :
Name, quantity, weight of plant goods loaded at the intermediate ports and the names of these ports:

Tn, s lng v khi lng hng thc vt cn bc cng ny:

Name, quantity and weight of plant goods to be discharged at this port:

Thuyn trng cam oan nhng iu khai trn l ng v chu trch nhim chp hnh y cc quy nh v
kim dch thc vt.
The Master guarantees the correctness of the above mentioned declarations and his responsibility for full
compliance with the said regulations on plant quarantine.

..., ngy thng nm 20

Date..............
THUYN TRNG (I L HOC S QUAN C
Y QUYN)
Master (Authorized agent or officer)

HNG HI VIT
NAM
v hng hi.

CNG HA X HI CH
NGHA VIT NAM
c lp - T do - Hnh phc
------------

CC HNG HI VIT CNG HA X HI CH NGHA

NAM
VIT NAM
Vietnam Maritime
c lp - T do - Hnh phc
Administration
Socialist Republic of Vietnam
Cng v hng hi. Independence - Freedom - Happiness
The Maritime
-----------Administration of........

LNH IU NG
LNH IU NG
SHIFTING ORDER

iu ng s:..

Knh gi: Thuyn trng tu..

To: master of M/V ............

u:
tch:.
tch ton phn:..

ng thuyn vin:.

ng hnh khch:....
neo u ti:.

di chuyn ti:

hi.gingy
iu ng:

gi.ngy./../.
GIM C

Gim c Cng v hng hi................ Yu cu tu.......

The Director of Maritime Administration of
requests the vess

ang neo u ti.Di chuyn ti

Anchoring/Berthing at
To be shifted to
Vo hi:gingythng .. nm..
At
hrs
on
month
year
L do iu ng:..
Reasons to shift
Yu cu ng thc hin nghim chnh lnh ny.
You are requested to comply in full this shifting order.
Giy php s:/CV
No
Ngy..thng. nm 20.
Date
GIM C
Director

HNG HI VIT
NAM
v hng hi.

CNG HA X HI CH
NGHA VIT NAM
c lp - T do - Hnh phc
------------

CC HNG HI VIT CNG HA X HI CH NGHA

NAM
VIT NAM
Vietnam Maritime
c lp - T do - Hnh phc
Administration
Socialist Republic of Vietnam
Cng v hng hi. Independence - Freedom - Happiness
The Maritime
-----------Administration of........

GIY PHP RI CNG

GIY PHP RI CNG
PORT CLEARANCE

php ri cng s:.. Tn tu:. Quc tch tu:.. H hiu:

Name of ship

u:
tch tu:

Flag State of ship

Call sign

Dung tch ton phn:.Tn thuyn trng:.

Gross tonnage
Name of master
S lng thuyn vin:..S lng hnh khch:.
Number of passenger

tch ton phn:. Number of crews

ng thuyn vin:..

ng hnh khch:.........
ha:
ha qu cnh:..

ng hi.gingy.thng..nm...

u lc n.gingy.thng..nm.

.gingy./../.
GIM C

Loi hng ha:..S lng:

Cargo
Volume
Loi hng ha qu cnh:..S lng
Transit cargo
Volume
Thi gian ri cng:..gingy.thng..nm.
Time of departure
Date
Cng n:.....
Next port of call
Giy php ri cng ny c hiu lc ngi....ngy.thng.nm
This port clearance is valid until
Giy php s:/CV
No

Ngy..thng.nm 20
Date
GIM C
Director

CC HNG HI VIT NAM

Vietnam Maritime Administration
Cng v hng hi.
The Maritime Administration
of..

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
Socialist Republic of Vietnam
Independence - Freedom - Happiness
---------------

GIY PHP QU CNH

PERMISSION FOR TRANSIT

1. Cho php tu:.. Quc tch tu:

Name of ship
Flag State of ship
H hiu:
Call sign
Tng dung tch:. GT Tn thuyn trng.
Gross tonnage
Name of master
S thuyn vin:.. S hnh khch.. Hng ha qu cnh:.
Number of crews
Number of passengers
Transit cargo
c php qu cnh Vit Nam t:..n:
Permitted to be in transit through Vietnam from
to
Khi hnh vo lc; ..gi ngy thng nm 20.
Time of departure
hour
date
month
year
2. Khi qu cnh, tu ny phi chp hnh nghim chnh quy nh ca php lut Vit Nam v cc iu
c quc t c lin quan m Vit Nam l thnh vin.
During transiting, the ship is bound to properly implement provisions of Vietnamese Laws, Regulations
and the International Treaties of which Vietnam is a contracting Party.
3. Giy php ny c gi tr n ngy..thngnm.
Valid until

S:/GPQC
No

Ngy.thngnm 20
Date..
GIM C
Director