Code Prefix Content Explanation Enter Vessel information here

Ship name/Call sign/Port of Ship name, Call sign, Port of registry of the
A registry/Current security level on ship, Current security level e.g. IBIS PACIFIC,9V2478,SINGAPORE,1
board
SHIPNAME, ABCD, PANAMA, 1

Time of report in UTC. 6 digit date time group

giving day of the month and hours and minutes
B Time of report in UTC followed by the month e.g. 112345 December

251600 April

The position of the ship at the time of reporting.

4 digit group giving latitude in degrees and
minutes suffixed with ‘’N’’ (north) or ‘’S’’ (south)
and 5 digit group giving longitude in degrees
C Position 0606 S 07807E
and minutes suffixed with ‘’E’’ (east) or ‘’W’’
(west) e.g.

1350S 07412E

The type of ship written in full e.g.

D Ship type OIL/CHEMICAL TANKER
TANKER
3 digit group for the present true course being
E Course steered e.g. 232
220
The ship’s speed in knots e.g.
F Speed 13.2
15.3 or 8.1

IMO ship identification number e.g.

G IMO number 9358955
1234567
 Confirmation yes or no (Y/N) and issuing
ISSC confirmation on authority e.g.
H Y,Lloyd's Register
board/Issuing authority
Y, Panama

Business name of ship’s agent at Shipping agent company name e.g.

I RENNIES
intended First SA port of call
RENNIES

Name of first SA port of call or OPL and ETA

First SA port of call or SA Off Port (DDHHMM in UTC) and all subsequent SA
Limits (OPL) and ETA and all ports of call and ETAs (DDHHMM in UTC) in
subsequent SA ports of call and voyage order until departure from SA waters, PORT ELIZABETH-
J and first port of call after SA. e.g.
ETAs or OPL in voyage order until OPL,222300,SAVANNAH
departure from SA waters, and
first port of call after SA. DURBAN - OPL, 271000, PORT ELIZABETH,
301900, CAPE TOWN, 040500, BUENOS
AIRES
Cargo work NO
Stores NO
Spares and Equipment NO
Bunkers and Lubes NO
What activities will the vessel
do in Port ? Crew Change NO
J Please indicate with a 'Yes' or 'No' Potable Water NO
(IN PORT) against each option. Ship-to-Ship Operation (STS Ops) NO
If the reason is "Other" it must be Disembark Stowaways NO
briefly explained.
Disembark Supernumary, Survivors, others NO
Technical Services, Repairs. Drydock NO
Emergency - Force Majeure NO
Other (must be explained briefly) NO
Stores NO
Spares and Equipment NO
Crew Change Yes

What activities will the vessel

do at OPL ?
J
Please indicate with a 'Yes' or 'No'
(OFF PORT
against each option.
 Potable Water NO
What activities will the vessel Ship-to-Ship Operation (STS Ops) NO
do at OPL ?
J Technical Services NO
Please indicate with a 'Yes' or 'No'
(OFF PORT Bunkers and Lubes (PE & Ngqura only) Yes
against each option.
LIMITS)
If the reason is "Other" it must be Disembark Stowaways NO
briefly explained. Disembark Supernumary, Survivors, others NO
Emergency - Force Majeure NO
Other (must be explained briefly) NO
Tanker going to Durban SBM NO
VLSFO 949.44 MT/LSMGO 252.85
ROB: FO on board departure last Port
MT

ROB: FO arrival First South African Port VLSFO 380MT/LSMGO 252 MT

Type of FO: HSFO, LSFO, VLSFO, Other VLSFO & LSMGO

Does the Vessel have an approved fully

NO
IMO Sulphur Cap 2020 (0.5% operational EGCS ? Yes or No
m/m) EGCS details (Open Loop, Closed Loop or
K NA
Hybrid)
First SA port of call or Off Port
Limits (OPL).
Frequency & Last Date of Wash Water Testing NA

Any malfunction of EGCS to be reported to

SAMSA at PAN@samsa.org.za and to the Port NA
Authority

Details of FONAR report, if applicable. NA

 Last port of call and country of call, Departure
date in 8 digit group (DDMMYYYY), Security
level, Were any special or additional security
Last port of call, Departure date, measures taken by ship during the ship-port
Ship security level, Security interface?, Were the appropriate security Pasir
P1
measures and procedures, Ship to procedures maintained during ship to port Gudang,Malaysia,05122022,1,NIL,Y
port facility measures facility activity in this port? (Y/N), e.g.

PORT KLANG,MALAYSIA,15032020,1, NIL,Y

Second last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Second last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the Port
P2 appropriate security procedures were
measures and procedures,Ship to Kelang,Malaysia,30112022,1,NIL,Y
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

SINGAPORE,SINGAPORE,11032020,1,NIL,Y

Third last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Third last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the Lubuk Gaung,
P3 appropriate security procedures were
measures and procedures,Ship to Indonesia,27112022,1NIL,Y
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

YOKOHAMA,JAPAN,08032020,2,APPOINTED
SECURITY COMPANY,Y
 Fourth last port of call and country of
call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Fourth last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the
P4 Pelintung, Indonesia,23112022
measures and procedures,Ship to appropriate security procedures were
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

SYDNEY,AUSTRALIA,29022020,1,NIL,Y

Fifth last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Fifth last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the
P5 appropriate security procedures were Batam,Indonesia,18112022,1NIL,Y
measures and procedures,Ship to
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

CARTAGEN,COLOMBIA,04022020,1,NIL,Y

Sixth last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Sixth last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the Port
P6
measures and procedures,Ship to appropriate security procedures were Qasim,Pakistan,07102022,1NIL,Y
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

LAGOS,NIGERIA,20012020,1,NIL,Y
 Seventh last port of call and country of
call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Seventh last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the
P7 Kandla,India,01102022,1NIL,Y
measures and procedures,Ship to appropriate security procedures were
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

WALVIS BAY,NAMIBIA,05012020,1,NIL,Y

Eight last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Eight last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the
P8 appropriate security procedures were Beira,Mozambique,16092022,1NIL,Y
measures and procedures,Ship to
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

MAPUTO, MOZAMBIQUE,29122019,1,NIL,Y

Ninth last port of call and country of

call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Ninth last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the San
P9 appropriate security procedures were
measures and procedures,Ship to Lorenzo,Argentina,22082022,1NIL,Y
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

LUANDA,ANGOLA,17122019,1,NIL,Y
 Tenth last port of call and country of
call,Departure date in 8 digit group
(DDMMYYYY),Security level,Any special or
Tenth last port of call,Departure additional security measures taken by ship
date,Ship security level,Security during the ship-port interface,That the
P10 Santos,Brazil,11082022,1NIL,Y
measures and procedures,Ship to appropriate security procedures were
port facility measures maintained during ship to port facility activity in
this port (Y/N) e.g.

LAGOS,NIGERIA,13122019,1,NIL,Y

Name of registered owner (or bareboat

charterer) ,contact address,Telephone IBISPACIFIC SHIPPING PTE
number,Fax number,E-mail address (if LTD,NO 1 KIM SENG
Registered owner (or bareboat applicable) e.g. PROMENADE,#07-02 GREAT
Q
charterer) and contact details WORLD CITY,SINGAPORE
237994,+6567333500,ptmmarine@pa
SA SHIPPING,PO BOX 111 CAPE TOWN, cctanker.com.sg
+21545383,+21545383,
SHIPPING@SHIPPING.NET.ZA

Name of ship security officer,Rank of ship

security officer e.g. MARK ESMILLA LESTER
R Ship security officer details
SOBREDO,CHIEF OFFICERIBIS
RODRIGUES,MASTER

Name of company security officer,contact

telephone number,Mobile telephone number,e-
mail address (if applicable) e.g. CAPT.AZHAR ASLAM,
S Company security officer details +6568396078,azharaslam@pacctank
er.com.sg
HOUTON,
+215453824,0824352514,JHOUTEN@SHIPPI
NG.NET.ZA
 General description of cargo on board and
hazardous cargo as per IMDG code e.g.

RB PKO - 3974.507 MT / RBD POSG

- 5993.078 MT / RBDP STRS -
1490.084 MT / RBD POMB -
8297.511 MT / RBDP STRM -
U Details of cargo
RPO: 15041.5mt 5985.857 MT / RBD PKS - 1000.594
RPKS: 2392.2mt MT / RBD OLN - 1789.040 MT /
RPKO: 2388.3 mt CCNO - 1993.537 MT / COCHIN -
CCNO: 6398.5 mt 2699.682 MT

Information about All weapons, ammunition and

associated equipment not declared as Cargo
and Pyrotechnics listed under U, used in the
defense of the vessel from attacks by pirates or
criminals. The provision of this information
does not negate the requirement to have a valid
South African Police Service (SAPS) issued
permit for the weapons. The following
1. Weapons on board - for use by information is to be provided:
appointed security personnel to
protect the vessel from Piracy and Number of firearms
Armed Robbery at sea.
Firearm calibre & Serial No.
Z1-Z(x) NA
Make and model
2. Details of Ammunition on board
and ammunition used to be Number and calibre of ammunition
declared - whether used for
training or defense of the vessel. Import/ Export permit No.
2. Details of Ammunition on board
and ammunition used to be
declared - whether used for
training or defense of the vessel.

Description/ method of storage whilst on

board
Country where embarked
Confirmation of the weapons used in the
defense of the vessel during the last 3
months
W1-W(x) Details of crew members' Information
Details about persons on board designated as crew showing surname, name, gender, birth date (DDMMYYYY), n
W1/SOAP,JOE,JM,MALE,01121974,SRI LANKAN,SCX142361,23012021,3rd Engineer,17092019
W2/MILLS,EDWARD,ER,MALE,13051980,PHILLIPINE,PRC2511X,30042020,2nd Mate,17112019
Crew Gender Birth Date
Family Name Given Names Initials
(W) (M/F) (DDMMYYYY)

1 Singh Jaswinder M 30031982

2 Esmilla Mark Lester M 03101989
3 Singh Gomendra Pratap M 15111992
4 Islam MD Zahirul M 01111995
5 Bantolo Novbie Fajar M 03111996
6 Aziz Md Tauhid M 08121981
7 Chowdhury Sajjad Hossen M 18011990
8 Karl Arim M 02081989
9 Uddin Mohammad Nizam M 05021975
10 Sharma Kashish M 02081991
11 Htwe Kan M 02021979
12 Withana Nayanapriya M 01071976
13 Thein Tun M 27081976
14 Dawe Ashkan Aslam M 29101991
15 Kazi Akhlaque Moosa M 25051978
16 George Tyrone M 12021985
17 Muyong Pasilaban M 03051996
18 Hasanudin Aan M 10051981
19 Sambas Andrean M 01101974
20 Aswan Aswan M 20111991
21 Bansal Priyanka F 07081998
22 Ramalingam Gowtham M 04061992
23 Aljohn Ganade M 24061975
24 Anand Kapruwan M 15051994
25 Chauhan Harendra M 17081990
 gender, birth date (DDMMYYYY), nationality, travel document number, document expiry date, e.g.
ngineer,17092019
d Mate,17112019
Travel Document Document Expiry Date Crew member's
Nationality Date joined ship
Number (DDMMYYYY) rank

INDIAN Z4707349 5092028 Master 03082022

FILIPINO P9459908B 31032032 C/O 03082022
INDIAN Z6085913 28092030 2/O 03082022
BANGLADESHI EB0969035 21092024 3/O 17062022
INDONESIAN C4573131 02082024 3/O 19112022
BANGLADESHI BY0101673 01122023 C/E 14092022
BANGLADESHI B00006888 30092030 2/E 03082022
FILIPINO P7600331B 13092031 2/E 19112022
BANGLADESHI EG0129376 28062025 3/E 17062022
INDIAN Z6421489 22092031 4/E 14092022
MYANMAR MD719696 07112023 EE 04082022
SRI LANKAN N7361255 07032028 Bosun 03082022
MYANMAR MF663345 11022027 P/Man 14092022
INDIAN S1710123 17042028 AB 17062022
INDIAN U7098361 03122030 AB 14092022
FILIPINO P9772144B 25042032 AB 03082022
FILIPINO P6528167B 21032031 OS 14112022
INDONESIAN E0645200 21092027 OLR 10112022
INDONESIAN C4970525 23092024 OLR 10112022
INDONESIAN C5796925 31122024 OLR 10112022
INDIAN Z4844177 06032029 D/C 03082022
INDIAN P2308522 21072026 E/C 30092022
FILIPINO P5651765B 18102030 C/Cook 19112022
INDIAN L6162588 18122023 Messman 29102022
INDIAN T1199412 12062029 Welder 30092022
Crew Additional Info
X1-X(x) Details of passengers
Information about persons on board designated as passengers showing surname, name, gender, birth date(DDMM
X1,SWART,HANS,MALE,07041970,SOUTH AFRICAN,C78965,15052005
X2,SEYMOUR,MARY,FEMALE,18031974,BRITISH,C65490,21082006
NOTE: Passenger vessels are not required to complete this Passenger List (for privacy reasons) but to co
Passenger Gender Birth Date
Family Name Given Names Initials Nationality
(X) (M/F) (DDMMYYYY)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
me, gender, birth date(DDMMYYYY),nationality, travel document number, document expiry date .e.g.

r privacy reasons) but to comply with the Department of Home Affairs (DHA) Passenger List requirement.
Travel Document Document Expiry Date
Passenger Additional Info 1
Number (DDMMYYYY)
ment expiry date .e.g.

assenger List requirement.

Passenger Additional Info 2
Y1-Y(x) Details of persons employed aboard, other than passengers or crew, with the reason for them being on board
Information about all persons employed aboard the vessel to defend the vessel from attacks by pirates or criminals sh
nationality, passport number and reason for being on board (if available) e.g.
Y1, BLOGGS, HENRY, MALE, 06111949, SOUTH AFRICAN, C12345, SURVIVOR.
Y2, COE, JOAN, FEMALE, 02101954, SOUTH AFRICAN, C12346, SURVIVOR.
Y3, FRIDAY, JOE, MALE, 30041994, SOUTH AFRICAN, C67890, STOWAWAY
Y4, BUTLER, JOSH, MALE, 11021955,SOUTH AFRICAN, C7657890, SUPERNUMERARY
Other Gender Birth Date
Family Name Given Names Initials Nationality
(Y) (M/F) (DDMMYYYY)
or them being on board
acks by pirates or criminals showing surname, full name, gender, date of birth (DDMMYYYY),

Travel Document Document Expiry Date Reason for being

Other Additional Info 1
Number (DDMMYYYY) onboard
Other Additional Info 2
YS1-YS(x) Details of Security Personnel on board
Information about Security Personnel showing surname, full name, gender, date of birth (DDMMYYYY), status, natio
YS1,MILITARY,N,SMALL,HAROLD,MALE,20121969,BRITISH BA109343,MOMBASA, DIPNOTE N84765F, TEAMLEAD
YS2,CIVILIAN,N,MUIR,JOE,MALE,09041978,SOUTH AFRICAN,C198546,GUARD

Security Gender Birth Date

Family Name Given Names Initials Status
(YS) (M/F) (DDMMYYYY)
irth (DDMMYYYY), status, nationality, passport number, document expiry date, port embarked, date employed, security company name, a
IPNOTE N84765F, TEAMLEAD

Document Expiry
Travel Document Date employed
Nationality Date Port embarked
Number (DDMMYYYY)
(DDMMYYYY)
te employed, security company name, address and contact details, e.g.

Security Company Security Company

Security Company Additional 1 Additional 2
address: Contact number: