1. Name of ship 2. Port of arrival / departure 3.

Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 3.SAILING TO / FROM

LIBERIA XIAMEN / CHINA

Call Sign 5LFJ7 Master

period of stay Capt. CEZARY KIDA

person on board

23
of arrival / departure

13.10.2022
0

HINA
15.01.2024
01.01.2100

0 0
1

aga

aga

ana

cinek

jarecki

kicia

legio

marek

mario

monia

roman

second

tobi
prov.l.
 Port: HAYDARPASHA DATE 13.10.2022

VOY. 82

PORT OF CALL
ARRIVAL: NANJING / CHINA NEXT PORT 0

Date of Security level

No. Date of Arrival Name of Port Country UN locator
Departure port

1 01/07/2020 02/07/2020 Constantza Romania ROCND 1

2 11/06/2020 15/06/2020 Constantza Romania ROCND 1
3 06/06/2020 10/06/2020 TERKIRDAG MARTAS Turkey TRTEK 1
4 01/06/2020 05/06/2020 GEMLIK Turkey TRGEM 1
5 28/05/2020 29/05/2020 SUEZ CANAL Egypt EGSUZ 1
6 30/04/2020 05/05/2020 DONGZAO CHINA CNNTG 1
7 25/04/2020 28/04/2020 SHANGHAI CHINA CNSHA 1
8 17/04/2020 21/04/2020 KOBE Japan JPUKB 1
9 15/04/2020 15/04/2020 BUSAN REPUBLIC OF KOREA KRPUS 1
10 10/04/2020 12/04/2020 XINGANG CHINA CNTXG 1
11 08/04/2020 09/04/2020 DALIAN CHINA CNDLC 1
 PORTS OF CALL LIST
✘ Arrival Departure
Ships Name Port of arrival /departure Date
KRASZEWSKI NANJING / CHINA 13.10.2022
Nationality Last / Next port Voyage No.
LIBERIA XIAMEN / CHINA 50
UN Arrival Departure SECURITY
PORT NAME
Code DATE DATE LEVEL
1 BURGAS BGBOJ 24-Aug-22 24-Aug-22 ONE

2 RIZE TRRIZ 18-Aug-22 21-Aug-22 ONE

3 KOPER SIKOP 11-Aug-22 12-Aug-22 ONE

4 HAYDARPASA TRHAY 20-Jul-22 30-Jul-22 ONE

5 HAIFA ILHFA 15-Jul-22 15-Jul-22 ONE

6 SUEZ CANAL EGSUZ 13-Jul-22 14-Jul-22 ONE

7 DACHAN BAY CNDCB 17-Jun-22 20-Jun-22 ONE

8 TAICANG CNTAC 13-Jun-22 14-Jun-22 ONE

9 SHANGHAI CNSHA 5-Jun-22 13-Jun-22 ONE

10 MASAN KRMAS 2-Jun-22 3-Jun-22 ONE

Master

C.KIDA
 IMO SHIP'S STORES DECLARATION
CANTEEN STORE LIST
Page No
X Arrival Departure 1
IMO Convention on Facilitation of International Maritime Traffic

1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 bond store
9. Name of article 10. Quantity 11.For official use
1 SOFT DRINKS 35 crnts
2 BEER 17 crnts

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

IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
BONDED STORE LIST
Page No
X Arrival Departure 1
IMO Convention on Facilitation of International Maritime Traffic

1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
24 0 bond store
9. Name of article 10. Quantity 11.For official use
1 cigarettes (1 crnt / 200pcs) 75 crnts
2 spirit 1ltr 14 btls
3 wine 23 btls

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

IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
SHIP CURRENCY LIST
Page No
Arrival x Departure 1
IMO Convention on Facilitation of International Maritime Traffic

1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 MASTER SAFE
9. Name of article 10. Quantity 11.For official use
1 USD 8416 USD
2 EURO NIL EURO

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

IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION

Page No
X Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 provision/storage place / bonded store
9. Name of article 10. Quantity 11.For official use

BONDED STORES
1 Cigarettes (1 crnt -200pcs) 99 crtn(s)
2 Spirit 1 ltr 41 bottle(s)
3 wine 12 bottle(s)
4 Beer 28 cs

DECK & ENGINE STORES

1 Fresh water ton(s)
2 Fuel Oil / LSFO ton(s)
3 Diesel / ULSMGO ton(s)
4 Lubricating Oil ltr(s)
IMO Convention on Facilitation of International Maritime Traffic

5 Paint 1996 ltr(s)

6 Thinner 230 ltr(s)
7 TV sets 5 pc(s)
8 Printer 8 pc(s)
9 Computer sets 9 pc(s)
10 Copy machine 2 pc(s)
11 Washing machine 6 pc(s)
12 Microwave oven 3 pc(s)
13 Karaoke set 1 pc(s)
14 Refrigerator 17 pc(s)

PROVISION
1 Soft Drinks 20 crtn(s)
2 Fresh vegetables 140 kg(s)
3 Fish in tins 50 tin(s)
4 Rice 250 kg(s)
5 Milk 320 ltr(s)
6 Juice 60 ltr(s)
7 Cooking oil 80 ltr(s)
8 Flour 75 kg(s)
9 Coffee 8 kg(s)
10 Sugar 70 kg(s)
11 Poultry 200 kg(s)
12 Meat 450 kg(s)
13 Fruit 40 kg(s)
14 Egg 1000 pc(s)
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
PROVISION LIST
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 stores
9. Name of article 10. Quantity 11.For official use
1 Meat fresh & frozen 435 kg(s)
2 Ham & Bacon 18 kg(s)
3 Sausages 58 kg(s)
4 Poultry 200 kg(s)
5 Fish assorted 10 kg(s)
6 Cookoing Oil & Lard 80 ltr(s)
7 Butter & Margarine 15 kg(s)
8 Cheese 30 kg(s)
9 Eggs 1000 pc(s)
10 Milk 320 ltr(s)
IMO Convention on Facilitation of International Maritime Traffic

11 Flour 75 kg(s)
12 Bread 20 pc(s)
13 Rice & Barley 305 kg(s)
14 Macaroni 30 kg(s)
15 Peas, Beans & Cereals 30 kg(s)
16 Sugar 70 kg(s)
17 Salt 20 kg(s)
18 Coffe 8 kg(s)
19 Coffee instant 26 jar(s)
20 Tea 4 kg(s)
20 Potatoes 80 kg(s)
21 Vegetables Fresh 140 kg(s)
22 Vegetables Frozen 60 kg(s)
23 Fruits 38 kg(s)
24 Souces, spices 10 kg(s)
25 Cakes / Sweets 10 kg(s)
26 Juices 60 50
27 Meat in Tins 30 tin(s)
28 Fish in tins 50 tin(s)
29 Vegetable / fruits in tins/jars 30 tin(s)
30 Cucumbers in jars 20 jar(s)
31 Marmolade / jam in jars 5 jar(s)
32 Beer 28 crnt(s)
33 Soft Drinks 20 crnt(s)
34 Mineral Water 25 case(s)
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
DECK STORES
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 deck stores
9. Name of article 10. Quantity 11.For official use
1 MOORING SYNTETIC ROPE 20 pcs
2 TOWING STEEL WIRE ROPE 1 pcs
3 SPARE WIRE ROPE FOR CRANE 0 rmtr
4 SPARE WIRE ROPE 150 mtr
5 POLIPROPYLENE ROPE -ass- 300 mtr
6 CANVAS COVERS 12 pcs
7 TARPOULIN FOR GARBAGE 1 pcs
8 WIRE SLINGS ASSORTED 20 pcs
9 PORTLAND CEMENT 0 kgs
10 PAINTS ASSORTED &THINNER 1996 ltr
12 GREASE & CAROSENE 50 kgs
13 PAINT BRUSH 55 pcs
14 PAINT ROLLERS 85 pcs
15 HOLD TERMOMETER/SALINOMETER 2 pcs
16 OXYGENOMETER 1 pcs
17 ELECTRIC SAW 1 pcs
18 ELECTRIC DRILL 4 pcs
19 PNEUMATIC SCALLING HAMMER 6 pcs
20 PNEUMATIC CHIPPER 6 sets
21 ELECTRIC SCALLING MACHINE 1 pcs
22 DIGITAL PHOTO CAMERA 2 pcs
23 PNEUMATIC TOOL-SF 11 1 pcs
24 HIGH PREASSURE WASHING MACHINE +RUBBER HOSE 1 SET
25 PLASMA MACHINE SET 2 SET
26 GASOLIN 45 ltr
27 GRINDING MACHINE 9 pcs
28 MACH.SAW/GASOLINE 1 pcs
29 POLIPROPYLENE CARGO SLINGS 65 pcs
30
31
12 Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
ENGINE STORE
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 engine stores
9. Name of article 10. Quantity 11.For official use
1 Fuel Oil (HFO) mt
2 Gas Oil (MGO) mt
3 Lubricating Oil mt
4 Fresh water mt
5 Grease 300 kg(s)
6 CHEMICALS&KEROSENE 1600 ltr(s)
7 Freon 70 kg
8 ME BEARINGS 1 pc(s)
9 pc(s)
IMO Convention on Facilitation of International Maritime Traffic

ME CYL.LINER 1
10 ME CYL.COVER 1 pc(s)
11 ME FUEL INJECT.VALVE 12 pc(s)
12 ME START VALVE 2 pc(s)
13 ME PISTON COMPL. 1 pc(s)
14 ME PISTON UPPER PART 1 pc(s)
15 ME PISTON LOWER PART 1 pc(s)
16 ME TURBO CHARGER ROTOR 0 pc(s)
17 ME WATER GUIDE JACKET 0 pc(s)
18 AE CYL LINER HEAD 6 pc(s)
19 AE CRANK SHAFT BEAR 6 pc(s)
20 AE CYL LINER 2 pc(s)
21 AE PISTON 1 pc(s)
22 AE OIL PUMP 2 pc(s)
23 ME NOZZLE FOR INJECTION 12 pc(s)
24 ME T/CH BEARINGS 0 pc(s)
25 BALL BEARINGS 120 kg(s)
26 SPARE VALVE 14 pcs
27 BRASS ROD AND HEXAGON 60 kgs
28 PLASTIC STEEL 2 kgs
29 COPPER GAUZE FOR FILTER 0 kgs
30 COPPER PIPE 30 m
31 GAS CYLINDERS ASSORTED 8 pcs
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
CATERING STORE
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 stores
9. Name of article 10. Quantity 11.For official use
1 "STEWARD"
2 Washing machines 9 pcs
3 Tumbler dryer 1 pcs
4 Vacuum cleaner 2 pcs
5 Fan 3 pcs
6 Ricecooker 2 pcs
7 Refrigerators 28 pcs
8 Coffee makers 2 pcs
9 5 pc
IMO Convention on Facilitation of International Maritime Traffic

TV set
10 Wireless Radio 25 set
11 PC computers 11 set
12 Laptops PC 1 pc
13 Copy machine 2 pc
14 DVD Player 3 pc
15 Laser printer 6 pc
16 Ink printer 5 pc
17 Electric irons 1 pcs
18 Heater 3 pcs
19 Electric universal slicer 1 pcs
20 Electric Toster 2 pcs
21 Microwave 1 pcs
22 Air purifier 1 pcs
23 Electric kettle 2 pcs
24 Blanket's covers 4 pcs
25 Pillows NIL pcs
26 Pillow's covers NIL pcs
27 Bed sheets NIL pcs
28 Blankets + guilt NIL pcs
29 Towels assorted /frotte/ NIL pcs
30 Karaoke set 1 pcs
31 Spoons,knifes etc 90 pcs
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
CHEMICALS LIST
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 engine stores
9. Name of article 10. Quantity 11.For official use
1 Air Cooler Cleaner 75.0 ltr(s)
2 Aquatuff / Alcaclean HD 40.0 ltr(s)
3 Carbon Remover Marichem CR-LT 75.0 ltr(s)
4 Sea Clean / Tank Cleaner S 0.0 ltr(s)
5 Cold Wash / Oil & Grease remover 0.0 ltr(s)
6 Condensate Control / Marichem CCI 15.0 ltr(s)
7 Descaling Liquid / Descaler Liquid555 55.0 ltr(s)
8 Disclean / Purifier Disc Cleaner 75.0 ltr(s)
IMO Convention on Facilitation of International Maritime Traffic

9 Electrosolv-E 30.0 ltr(s)

10 Enviroclean / Liquid Soap 20.0 ltr(s)
11 Gamazyne 700FN / Bioactive powder 40.0 kg(s)
12 Liquitreat / BWT New Formula 30.0 ltr(s)
13 Rocor NB Liquid/DCWT Non Chromate 70.0 ltr(s)
14 SeaCare OSD/Oil Spill Emulsifier 205.0 ltr(s)
15 Soot Remover / Soot Cleaner 50.0 kg(s)
16 Metal Brite/Rust Remover 65.0 ltr(s)
17 Vaptreat/Evaporator Treatment 40.0 ltr(s)
18 Calcium Hypochlorite 0.0 kg(s)
19 Kerosene 15.0 ltr(s)
20 Coolant Additive / Anti Freeze FO-2 36.0 ltr(s)
21 Cleanbreak / SolbreakOxygene 30.0 ltr(s)
22 Oxygene 4.0 cyl
23 Acetylene 2.0 cyl
24 Alcative Liquid 90.0 kg(s)
25 Gamazyne BTC 25.0 ltr(s)
26 Amergy 222 25.0 ltr(s)
37 Ultrasonic Cleaner 25.0 ltr(s)
28 Natural hand cleaner 5.0 kg(s)
29 Soft Soap 0.0 kg(s)
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
PYROTECHNIC LIST
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI voy. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 bridge, lifeboat
9. Name of article 10. Quantity 11.For official use
1 Hand red flares 6 pcs
2 Rocket parachute flares 4 pcs
IMO Convention on Facilitation of International Maritime Traffic

3 Buoyant orange smoke 2 pcs

4 Line throwing apparatus 4 pcs
5 Rocket parachute flares 12 pcs
6 Boyant Orange Smoke Signal: JHB-4 2 pc(s)

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

IMO FAL
Form 3
 IMO CLASS CARGO DECLARATION

Page No
X Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage

23 0 CARGO HOLD : No1, No3P+No4S / DECK

9. Name of article 10. Quantity 11.For official use

1 IMO CLASS 1.2 E 588000 kgs

2 IMO CLASS 1.1 B 4492 kgs
IMO Convention on Facilitation of International Maritime Traffic

3 IMO CLASS 1.1 D 279240 kgs

4 IMO CLASS 1.1 E 260880 kgs
5 IMO CLASS 1.4 S 53760 kgs
6 IMO CLASS 9 11240700 kgs
TOTAL 12427072 kgs

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

IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
NAVIGATIONAL EQUIPMENT
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 BRIDGE
9. Name of article 10. Quantity 11.For official use

1 Portrable VHF 13 pcs

2 GMDSS equipment 2 set
3 Aldis 1 pcs
4 Anemometr 1 pcs
5 Binoculars 6 pcs
6 Calculators 8 pcs
7 Chronometer 2 pcs
8 Photo camera 1 pcs
9 2 pcs
IMO Convention on Facilitation of International Maritime Traffic

Sextant
10 Psychometer 1 pcs
11 Satellite phone irydium-portable 1 pcs
12 Chineese mobile phone 2 pcs
13 AIS SART 2 pcs
14 Spare magnetic compass 1 pcs
15 Barograph 1 pcs
16 Barometr 1 pcs
17 VHF DSC 2 pcs
18 MF/HF DSC 1 pcs
19 GMDSS TWO-WAY VHF RADIO 3 pcs
20 ECDIS 2 pcs
21 Radar 2 pcs
22 WEATHER FACSIMILE 1 pcs
23 ECHO SOUNDER 1 pcs
24 SPEED LOG 1 pcs
25 COURSE REPEATER 1 pcs
26 GPS 2 pcs
27 AIS 1 pcs
28 VDR 1 pcs
29 GYRO COMPASS 1 pcs
30 GYRO COMPASS REPEATER 3 pcs
31 EPIRB 2 pcs
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
NIL LIST
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0
9. Name of article 10. Quantity 11.For official use

We declare:
IMO Convention on Facilitation of International Maritime Traffic

Mail NIL
Stowaways NIL
Passengers NIL
Landing Parcels NIL
Through Parcels NIL
Animals NIL
Arms & Ammunition NIL

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

IMO FAL
Form 3
 IMO SHIP'S STORES DECLARATION
BOUNDED STORE LIST
Page No
x Arrival Departure 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

KRASZEWSKI VOY. 50 NANJING / CHINA 13.10.2022

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA XIAMEN / CHINA

6. Number of persons on board 7. Period of stay 8. Place of storage
23 0 bond store
9. Name of article 10. Quantity 11.For official use

1 IRIDIUM 9555 IRIDO115A L5 36015 B031PG Satellite 1 set IMEI:300115010004390 / SIM 8988169326002540106
IMO Convention on Facilitation of International Maritime Traffic

2
3
8
9
10
11
12
13
14
15
16
17
12
13
12. Date and signature by master, authorised agent or officer.
IMO FAL
Form 3
 SHIP'S GENERAL DECLARATION
B. No ARRIVAL
1. Name & description (type) of ship and voyage number 2. Port of entry/departure 3. Date and time of arrival/departure

KRASZEWSKI GENERAL CARGO VESSEL 50 NANJING / CHINA 13.10.2022

4. Nationality of Ship 5. Name of Master 6. Port arrived from 7. Purpose of visit / special requirement

LIBERIA Capt. CEZARY KIDA XIAMEN / CHINA Cargo Operation

8. Certificate of Registry (Port, date, number) 9. Year built 10. Name & address of ship's agents

23.05.22
Monrovia 22.11.22
441-22-NYC 2011 KRISHNA SHIPPING & ALLIED SERVICEC

11. G.R.T. 12. N.R.T 13. Dead Weight

24221 10824 30300

14. Call Sign 15. L.O.A. 16. Beam

5LFJ7 199.757 m 27.393 m

17. Air Draft mtrs 18. Draft FWD mtrs 19. Draft Aft mtrs
41.70 8.20 9.40
20. Gear / Gearless 21. Position of bridge 22. Quarantine Y/N

Gear (4 cranes) Aft N

23. Position of ship in the port (berth or station)

BERTH No 8

26. Brief particulars of voyage (previous and subsequent port of call, underline wher remaining cargo will be discharged

Port off Calls:

RIZE - TURKEY 21.08.2022 , BURGAS - BULGARIA 24.08.2022, DERINCE TURKEY 27.08.2022; AQABA - JORDAN 02.09.2022;
JEDDAH - SAUDI ARABIA 05.09.2022
Cargo for:
XIAMEN , CHINA
27. a Brief description of total quantity of cargo 27. b Cargo for this port 27. c Cargo in transit
11240,7 mt Copper Concentrate NIL 11240.7 mt

28. No. of crew (including Master) 29. No. of Passengers 30. Dangerous cargo description with IMO classification
23 NIL
11240,7 mt Copper Concentrate IMO CLASS 9

Attached Documents 31. P.C. Number

(indicate Numbers of Copies)

33. Manifests 34. Ship's Stores Declaration 35. Remarks
NIL 1

36. Crew list 37. Passenger List

1 NIL
38. Crew Effects Declaration 39. Declaration of Health
1 1

40. Light dues receipt and N.D.C.

13.10.2022 Capt. CEZARY KIDA
41. Date and signature of master, authorized agent or officer.

FOR OFFICIAL USE ONLY BELOW DOTTED LINE

 MARITIME DECLARATION OF HEALTH
To be completed by the masters of ships arriving from foreign ports.
Submitted at the port of : NANJING / CHINA Date : 13.10.2022
Name of ship/vessel : KRASZEWSKI Registration/IMO No. : 9432153
Arriving from : XIAMEN / CHINA Sailing to : SINGAPORE
Nationality (Flag of vessel) : LIBERIA Master’s name : Capt. CEZARY KIDA
Gross tonnage (ship) : 24221 Net tonnage : 10824
Valid Sanitation Control Exemption/Control Certificate carried on board? *yes ✓ *no
Certificate No: 2022067101006 Issued at : HUALIEN Date: 24-Mar-22
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 30 days, whichever is shorter:
RIZE - TURKEY 21.08.2022 , BURGAS - BULGARIA 24.08.2022, DERINCE TURKEY 27.08.2022; AQABA - JORDAN 02.09.2022;
JEDDAH - SAUDI ARABIA 05.09.2022

List crew members, passengers or other persons who have joined ship/vessel since international voyage began or within past 30 days, whichever is
shorter, including all ports/countries visited in this period (add additional names to the attached schedule):
1. BURGAS; DERINCE;AQABA;
W.KRZEMINSKI Rank: ETO Date: 24.08.2022 Port: JEDDAH

2. S.KWIATKOWSKI Rank: 2ND ENG Date: 31.08.2022 Port: AQABA; JEDDAH

3
4
5
6

Number of crew members on board : 24

Number of passengers on board : 0
Health questions
(1) Has any person died on board during the voyage otherwise than as a result of accident? *yes *no ✓
If yes, state particulars in attached schedule.
(2) Is there on board or has there been during the international voyage any case of disease which you suspect to be of *yes *no ✓
an infectious nature?
If yes, state particulars in attached schedule.
(3) Has the total number of ill passengers during the voyage been greater than normal/expected? *yes *no ✓
How many ill persons? 0
(4) Is there any ill person on board now? *yes *no ✓
If yes, state particulars in attached schedule.
(5) Was a medical practitioner consulted? *yes *no ✓
If yes, state particulars of medical treatment or advice provided in attached schedule.
(6) Are you aware of any condition on board which may lead to infection or spread of disease? *yes *no ✓
If yes, state particulars in attached schedule.
(7) Has any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board? *yes *no ✓
If yes, specify type, place and date
(8) Have any stowaways been found on board? *yes *no ✓
If yes, where did they join the ship (if known)?
(9) Is there any sick animal or pet on board? *yes *no ✓
(10) Have the crew and passengers had any the certificate of vaccination? *yes ✓ *no
If have, how many ? 24
(11) Have the crew and passengers had any the certificate of health examination for international traveler ? *yes ✓ *no
If have, how many ? 24
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.
(b) With or without fever: (i) any acute skin rash or eruption; (ii) severe vomiting (other than sea sickness); (iii) severe diarrhoea; or (iv) recurrent
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.
Signed
Master
Date : 13.10.2022
Countersigned
* Please insert a “✓” in the appropriate space Ship's Surgeon (if carried)
D.H. 168E (2018)
 ATTACHMENT TO MARITIME DECLARATION OF HEALTH

Port, date joined Date of onset of Reported to a port Disposal of Drugs medicines or other
Name Class or rating Age Sex Nationality Nature of illness
ship/vessel symptoms medical officer? case* treatment given to patient

None

* 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.