MARITIME DECLARATION OF HEALTH
To be compteted and submitted to the competent authorities by the masters of ships arriving from foreign ports
submitted at the port ofr TANJUNG BUYUT, INDONESIA Date :
Name of ship/inland navigation vessel : M/V SEA SPIRIT Registration/l[rO No: 9345829
Arriving from : GO GlA, VIETNAM Sailing to i SINGAPORE
(NationalityxFlag of vessel) : LIBERIA Master's Name : CAPT. ROGER A. VEDEJA
cross tonnage (ship): 31,306 MT
Tonnage (inland navigation vessel)
Valid Sanitation Control Exemption/Control Certificate carried on board?
YES
lssued at r SATUI - BANJARMASIN Date 8 MAY 2024
Re-inspection required? NO
Has ship/vessel visited an affected area identified by the World Health Organisation? NO
Port and date of visit
List po(s of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter: GO GlA,
VIETNAM 26 MAY 2024 / BUNATI, INDONESIA 14 MAY 2024 / SINGAPORE 05 IIilAY 2024
Upon request ofthe 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, whicheve r is shorter, including all ports/countries visited in
this add additional names to the attached schedule)
('l ) Name: CONSTANTIN-LUCIAN
joined from: \1) 21 MAY 2024
(2) GO GrA, (3) ROMANTA
MOSOIU VIEINAM
(2) Name: RODRIGO N. JAVIER joined fromi ('1) 04 MAY 2024 (2) STNGAPORE (3) FtLtPtNO
(3) Name: ROSELS. FELECIO joined from: (1) 04 MAY 2024 (2) STNGAPORE (3) FtL|PTNO
(4) Namei REYMONO L. PEZ oined fro!'n: (1) 04 MAY 2024 (2) STNGAPORE (3) FrLrP!NO
Number of crew members on board r2'l
Number of pass rs on board: NIL
' Health Questions
(1) Has any person died on board during the voyage otheMise than as a result of ac.ideot? NO
lf yes, state particulars on attached schedule. Total no. of deaths
(2) ls there on board or has there been during the international voyage any case of disease which you suspect to be of an infectious
nature? NO lf , state particulars in attached schedule
(3) Has the total number of ill passenge rs during the voyage been greater that normal/expected? NO How many ill persons? NO
(4) is tltere any ill person on board now? NO lf yes, state particulars in attached schedule
(5) Was a medical practitioner consulted? NO lf yes, state particula.s 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? NO
lf yes, state particulars in attached schedule
(7) Has any sanitary measure (e.g. quarantine, isolation, disinfeclion or decontamination) been applied on board? NO
lf yes, , place and date
(8) Have any stowaways been found on board? No lf yes, when did they join the ship (if known)?
(9) ls there a sick animal or pet on board? NO
IIELC: ln the absence of a surgeon, the master should regard the following symptoms as grounds for suspecting the existence of a
disease of an infeclious nature:
(a) fqver, persisting for several days or accompanies by (i) prostration; (ii) decreased consciousness; (iii) glanduler
sv!,ell'ng; (iv) iaundice; (v) cough or shortness of breath; (vi) unusual bleeding; or (vii) paralysis.
(b) With orwithout fever; (i) any acute skin rash or eruptioni (ii) severe vomiting (othe. 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 beliel.
(
A Sp
Signed Countersigned
Ships Surgeon (if caried)
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Date
2A MAY 2024
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,ls*
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