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SHIP PRE-ARRIVAL SECURITY INFORMATION FORM

Version

Revision

Ene-16

Elaborado Por:

Revisado Por:

Aprobado Por:

Referencia

OPIP

Dennis Chinchilla

Daniel Escobar

SSE-R-043

FOR ALL SHIPS PRIOR TO ENTRY INTO THE PORT FACILITY OF


OPERADORA PORTUARIA CENTROAMERICANA (SOLAS REGULATION XI-2/9)
TO BE SUBMITTED TO THE PFSO FOR MARITIME SECURITY PURPOSES
OF THE PORT OF ARRIVAL

1 - Particulars of the ship and contact details


1.1 - IMO number
1.3 - Port of registry
1.5 - Type of ship
1.7 - Inmarsat call numbers (if available)
1.9 - Name of Company
1.11 - CSO name & 24 hr contact detail

1.2 - Name of ship


1.4 - Flag State
1.6 - Call Sign
1.8 Gross Tonnage
1.10 - IMO Company Identification Number

2 - Port and port facility information


PUERTO
CORTES

2.1 - Port of arrival

Port facility of arrival


(if known)

OPERADORA PORTUARIA
CENTROAMERICANA
(SOCPF No. HNPCR-24489-OPC-0030)

2.2 - Expected date and time of arrival of the ship in port


(ETA) (B/4.39.3 ISPS Code)

Cargo discharge / load

2.3 - Primary purpose of call

3 - Information required by SOLAS regulation XI-2/9.2.1


3.1 - Does the ship have a
valid International Ship
Security Certificate (ISSC)?
(XI-2 / 9.2.1.1)
(YES/NO)

ISSC No.

3.1.2 - NO
why not?

3.1.1 - Issued by
(name of Flag
Administration or
RSO)

Expiry date
(dd/mm/yyyy)

NA

3.1.2 - Does the ship have an


3.2 - Security Level at which the ship is
Security Security
Security
approved SSP on board?
currently operating? (XI-2/9.2.1.2)
Level 1
Level 2
Level 3
(YES/NO)
(YES/NO)
YES
X
3.2.1 - Location of ship at the time this
report is made (B/4.39.2 ISPS Code)
3.3 - List the last ten calls at port facilities in chronological order (most recent call first): (XI-2 / 9.2.1.3)
Date from
Date to
UNLOCODE
Port
No.
Port
Country
Security Level
facility
(dd/mm/yyyy) (dd/mm/yyyy)
(if available)
1
2
3
4
5
6
7
8
9
10

3.3.1 - Did the ship take any special or additional security measures, beyond those in the
YES
NO
approved SSP? If the answer is YES, indicate below the special or additional security
measures taken by the ship. (XI-2 / 9.2.1.4)
3.3.2 - No. (as above)
Special or additional security measures taken by the ship
1
2
3
4
5
6
7
8
9
10
3.4 - List the ship-to-ship activities, in chronological order (most recent first), which have been carried out during
the period of the last ten calls at port facilities listed above. Expand table below or continue on separate page if
necessary insert total number of ship-to-ship activities:
YES
NO
3.4.1 - Have the ship security procedures specified in the approved SSP been maintained during
each of these ship-to-ship activities? (XI-2 / 9.2.1.5)
3.4.2 - If NO, provide details of the security measures applied in lieu in the final column below.
Location or
Date from
Date to
Ship-to-ship
Security measures
Longitude and
No.
activity
applied in lieu
(dd/mm/yyyy) (dd/mm/yyyy)
Latitude
1
2
3
4
5
6
7
8
9
10
3.5 - General description of the cargo aboard the ship
(XI-2 / 9.2.1.6 e B/4.39.5 ISPS Code)
YES No
3.5.1 - Is the ship carrying any dangerous substances as
3.5.2 - If YES, confirm Dangerous
cargo covered by any of Classes 1, 2.1, 2.3, 3, 4.1, 5.1,
Goods Manifest (IMO FAL Form 7) (or
6.1, 6.2, 7 or 8 of the IMDG Code?
relevant extract) is attached
YES 3.7 - Confirm a copy of the ships
YES
3.6 - Confirm a copy of ships crew list is attached (I.M.O.
passenger list is attached (XI-2 /
FAL Form 5) (XI-2 / 9.2.1.6 e B/4.39.4 ISPS Code)
9.2.1.6 e B/4.39.6 ISPS Code)

4 - Other security related information


4.1 - Is there any security-related matter you
wish to report?

YES/NO

4.1.1 - Provide details:

5 - Agent of ship at intended port of arrival


5.1 - Name:

Contact details (Tel. no.):


6 - Identification of person providing the information
6.1 - Name:
Signature:
6.2 - Title or Position (delete as appropriate):
Agencia Naviera Universal

Master / SSO / CSO / Ships agent (as above)


Date/Time/Place of completion of report