人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人��ࡱ� > �� � � ���� � � ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� c �� v� bjbj�� � ��Qb��Qb[$ " = �� �� �� � � � ^ ^ � � � ���� � � � 8 , J l � O� < � � L% L �% �% �% �+ , , �� �� �� �� �� �� �� $ �� � A� ~ � � � $, �+ �+ ^ $, $, � ^ ^ �% �% � �0 �0 �0 $, R ^ �% ^ R �% �� �0 $, �� �0 �0 b � � � " �� �% ���� ��ZY�� ���� v, � b� V � � 0 O� �� � �� �, � �� � �� ƍ � �� � F� � $, $, �0 $, $, $, $, $, � � �. $, $, $, O� $, $, $, $, ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� �� $, $, $, $, $, $, $, $, $, � B $ : PLEASE PROVIDE THE FOLLOWING PRE-ARRIVAL INFORMATION AT LEAST 72 HOURS IN ADVANCE IN THE FOLLOWING FORMAT AND SAME SEQUENTIAL ORDER : PETROLEUM PORTS AUTHORITY DAS - email: HYPERLINK "mailto:ppadas@www.lia69719.com" ppadas@www.lia69719.com & HYPERLINK "mailto:tadas@adma.ae" tadas@adma.ae PORT CONTROL ROOM - email: HYPERLINK "mailto:vtisdas@www.lia69719.com" vtisdas@www.lia69719.com & HYPERLINK "mailto:pctas@adma.ae" pctas@adma.ae, VHF Ch.23,12 Fax: + 971 2 8733040 � Tele No.+971 2 6028996/28999 ADMA SHIPPING AGENCY: HYPERLINK "mailto:oscdas@adma.ae" oscdas@adma.ae & HYPERLINK "mailto:oasciidas@adma.ae" oasciidas@adma.ae Fax +971 2 6068188 Port Regulations are available on Petroleum Ports Authority website HYPERLINK "https://ppa.www.lia69719.com" https://ppa.www.lia69719.com Update ETA At 48, 24 and 12 Hours Prior To Arrival Contact Das VTIS on VHF Ch. 23, Port Control On VHF Ch. 16/12, at least four Hours before arrival. Please have the combination Pilot/Accommodati o n l a d d e r r i g g e d o n t h e L e e s i d e P i l o t S t a t i o n : D a s Z i r k u - N o r t h / L A T 2 5 0 1 0 . 0 0 N , L O N G 0 5 2 0 5 6 . 0 0 E . T h e b o a r d i n g p i l o t w i l l g r a n t p r a t i q u e . P A R T 1 S h i p ' s n a m e : F O R M T E X T P r e v i o u s n a m e ( s ) : F O R M T E X T I M O n u m b e r : F O R M T E X T O f f i c i a l N o . : F O R M T E X T E T A p i l o t b o a r d i n g s t a t i o n : F O R M T E X T F l a g : F O R M T E X T P o r t o f r e g i s t r y : F O R M T E X T N R T : F O R M T E X T G R T : F O R M T E X T S D W T : F O R M T E X T Y e a r b u i l t d e l i v e r e d d a t e : F O R M T E X T T y p e o f h u l l : F O R M T E X T T y p e o f s h i p : F O R M T E X T M a s t e r s n a m e : F O R M T E X T R e g i s t e r e d o w n e r s n a m e : F O R M T E X T R e g i s t e r e d o w n e r s a d d r e s s : F O R M T E X T R e g i s t e r e d o p e r a t o r s n a m e : F O R M T E X T R e g i s t e r e d o p e r a t o r s a d d r e s s : F O R M T E X T N a m e o f t h e a g e n t i n U A E : F O R M T E X T P A R T 2 L a s t p o r t o f c a l l : F O R M T E X T N e x t p o r t o f c a l l ( f o r P o r t C l e a r a n c e p u r p o s e o n l y ) : F O R M T E X T F i n a l d e s t i n a t i o n p o r t : F O R M T E X T L a s t l o a d p o r t i n U A E - n a m e : F O R M T E X T L a s t l o a d p o r t i n U A E - d a t e : F O R M T E X T V o y a g e n o : F O R M T E X T L a s t p o r t s t a t e c o n t r o l i n s p e c t i o n p l a c e / d a t e : F O R M T E X T C o n f i r m a v a i l a b i l i t y o f p o r t a p p r o a c h B A c h a r t ( 2 4 4 4 / 3 4 1 3 ) e i t h e r i n p a p e r f o r m o r o n t w o S O L A S a p p r o v e d , i n d e p e n d e n t , E C D I S u n i t s t h a t a r e d u l y c e r t i f i e d b y t h e v e s s e l s f l a g s t a t e : F O R M T E X T C o n f i r m p o r t r e g u l a t i o n s / p o r t i n f o r m a t i o n b o o k l e t a v a i l a b l e o n b o a r d : F O R M T E X T C o n f i r m v e s s e l h a s n o d e f e c t s w h i c h c o u l d e f f e c t t h e s a f e n a v i g a t i o n : F O R M T E X T I s t h e V e s s e l c o m p l i a n t w i t h t h e r e q u i r e m e n t s o f M A R P O L 7 3 / 7 8 A n n e x V I , o n S u l p h u r C a p - 2020: FORMCHECKBOX Yes FORMCHECKBOX No Is the vessel using Fuel with Sulphur content of 0.5% M/M : FORMCHECKBOX Yes FORMCHECKBOX No Is the vessel fitted with Exhaust Gas Cleaning System (Scrubber): FORMCHECKBOX Yes FORMCHECKBOX No If the answer to the above question is �Yes�, attach copy of the Class approval Certificate for Exhaust Gas Cleaning System (Scrubber). Confirm accommodation air conditioning/ventilating systems are operational with positive pressure, temp below 2 5 0 C : F O R M T E X T A r r i v a l d i s p l a c e m e n t : F O R M T E X T D e p a r t u r e d i s p l a c e m e n t : F O R M T E X T A r r i v a l m a x i m u m d r a f t : F O R M T E X T D e p a r t u r e m a x i m u m d r a f t : F O R M T E X T A r r i v a l f r e e b o a r d : F O R M T E X T L e n g t h o v e r a l l ( L O A ) : F O R M T E X T B e a m : F O R M T E X T C o n f i r m y o u r a c c e p t a n c e t o s i g n i n g a b o y c o t t d e c l a r a t i o n t o b e s u b m i t t e d t o t h e s u p r e m e p e t r o l e u m c o u n c i l s t a t i n g t h a t c a r g o l o a d e d a t D a s Z i r k u &