Port Clearance (Originial)

IMO GENERAL DECALARATION
Arrival Departure
2. Port of arrival/departure
1. Name and description of ship
3. Date-time of arrival/ departure
m/v "LENA-S." COLOMBO, SRI LANKA 16/Mar/2016 8:30
4. Nationality of ship 5. Name of master 6. Port arrived from / port of destination
Antigua & Barbuda Capt. TRUHN, UKASZ PATRYK SINGAPORE NEW YORK, U.S.A
7. Certificate of registry (port; date; number) 8. Name and address of ship's agent
ST. JOHN'S - 12 May 2010 - SSR-No 1882
9. Gross tonnage 10. Net tonnage Star Lanka Shipping (Pvt) Ltd.
IMO Convention on Facilitation of International Maritime Traffic
40541 24472
11. Position of the ship in the port (berth or station)

LKCBM - South Asia Gateway SAGT
12. Brief particulars of voyage (previous and subsequent ports of call; underline where remaining cargo will be discharged
From Da Chan Bay to Yantian,Yantian to Cai Mep, and last port Singapore.Total cargo onboard - 24810.4 mt. Total amount of cargo to be discharged in Colombo -
4529.1 mt. (151 x 20ft, 45 x 40ft, 1 rfr x 20ft, 2 rfr x 40 ft.). Remaining cargo to be discharged in U.S.A.
13. Brief description of the cargo
GENERAL CARGO IN CONTAINERS. (DG Onboard - 1817520 Kg )-total weight onboard; 24810.4 tons
14. Number of crew (incl master) 15. Number of Passengers 16. Remarks
22 NIL
Attached documents
(indicate number of copies) Vessel in good working condition, All Crew is healthy.
17. Cargo decalartion 18. Ship's stores declaration
NIL 1
19. Crew list 20. Passenger list 21. Date and signature by master, authorised agent or officer
1 NIL
22.Crew's effect declaration* 23. Maritime declartion of health*
1 1 Wednesday, March 16, 2016 Capt. TRUHN, UKASZ PATRYK
For official use
IMO FAL
Form 1
C94 * Only on arrival

DA CHAN BAY YANTIAN CAI MEP SINGAPORE COLOMBO NEW YORK1 SAVANNA NORFOLK SUEZ CANAL
Kind of Document IMO IMO IMO IMO IMO IMO IMO IMO IMO
local local local local local local local local local
PRE- PRE- PRE- PRE- PRE- PRE- PRE- PRE- PRE-
ARR ARR ARR ARR ARR ARR ARR ARR ARR
Form Form Form Form Form Form Form Form Form
form form form form form form form form form
1 Crew / Passenger List ( Passport ) 6 6 6 1 9 3 2 2 6 1
2 Maritime Health Declaration 1 2 2 1 1
3 Vaccination List 1 3 2 1 1
4 Ports of Call 4 4 4 1 3 2
5 Deratting Cert. ( Copy )
6 NIL List / ammunition List callao 2 2 2 3 1

7 Store List 3 2 1 3 3 2 2
8 Bonded Store List 1 2 3 2 2
9 Narcotic List 3 2 3 2
10 Crew / Passenger Effects 3 2 2 2 3 2 2
11 Crew Currency 2
12 Security Form (ISPS) - 1
13 Ship's Particulars
14 DG List 1
15 Oil Record Book ( Last Page) 1 1 1
16 Gabbage Record (Last Page) 1 1 1
17 Stowage plan for Cont. Ship 1 2
18 Port State Control / ISSC & CSR 3 3 1 1
19 WASTE NOTIFICATION- (C/O+CE)
ENOA/D - e-PANS (Ch. Off -
20
CDC)

IMO IMO IMO IMO IMO IMO IMO IMO IMO
local local local local local local local local local
PRE- PRE- PRE- PRE- PRE- PRE- PRE- PRE- PRE-
ARR ARR ARR ARR ARR ARR ARR ARR ARR
Kind of Document Form Form Form Form Form Form Form Form Form
form form form form form form form form form
CHINA CHINA VIETNAM SINGAPORE SRI LANKA U.S.A U.S.A U.S.A SUEZ CANNAL
Ship's Particulars " A" Ship's Particulars " A"

CrewList / SINGAPORE PASSENGER = PASSENGER = PASSENGER =
China form / ISPS Local China form / ISPS Local ISPS Local form Local Form ISPS
FORM CBP Form I-94(10/04) CBP Form I-94(10/04) CBP Form I-94(10/04)
form form Fill- up Egymar- Local
Form to send 7days /
CREW SHORE PASS = CREW SHORE PASS = CREW SHORE PASS =
REMARKS free arrival docs. CrewList - PP & NSB CrewList - PP & NSB CrewList - PP & NSB e-PANS before 24hrs. Local Form- Costom
CBP Form I-95(06/09) CBP Form I-95(06/09) CBP Form I-95(06/09)
Print for Canal
Authorities & Surveyor
- Only for Canal Trasit
All China ports Send 2 Years POC update Foreign to USA / E- E-Noad USA to USA E-Noad USA to USA
All Docs. Local forms.
before 5days and stdby NOAD before -- 5days - 2days - 2days
IMO
local
PRE-
ARR
Form
form
IMO
local
PRE-
ARR
Form
form
m/v "LENA-S."
INFORMATION SHEET St. John's (4586) Antigua & Barbuda
PASSPORT
Nr. Name Rank Nationality Date and Place of Birth Passport-No. EXPIRY Date
1 TRUHN, UKASZ PATRYK Master POLISH 22-Feb-1983 GDYNIA AT4669451 19-Jan-2018
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO 02-May-1978 MANDAUE CITY EB5029024 27-Mar-2017
3 TABANDA, RONALD BANO 2nd Off. FILIPINO 04-Jun-1978 ILOILO CITY EC3387899 05-Feb-2020
4 ERANI, DAVOR 3rd Off. MONTENEGRIN 19-Mar-1990 BERANE F84BZ5897 09-May-2021
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN 24-Nov-1961 TALLIN KB0745160 20-Dec-2018
6 CACHO, RUFINO CASTRENCE 2nd Eng. FILIPINO 11-Mar-1974 ANDA PANGASINAN EC6403068 13-Jan-2021
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO 28-Nov-1970 ILOCOS SUR EB7258820 30-Jan-2018
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO 07-Feb-1964 MEDELLIN CEBU EC6116517 30-Nov-2020
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO 01-Feb-1978 DAPITAN CITY EB7231344 23-Jan-2018
10 ANG, JOVITO BALIAD A/B FILIPINO 26-Jun-1969 HINUNANGAN S LTE EC4153790 11-May-2020
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO 18-Jan-1973 MANILA EC2864529 27-Nov-2019
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO 18-Sep-1985 MANILA EC5478600 24-Sep-2020
13 GENOSA, RYAN SEBONGA O/S FILIPINO 29-May-1987 HINIGARAN NEG OC EC4212610 19-May-2020
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO 01-May-1984 BACOLOD CITY EC2498528 21-Oct-2019
15 MARIN, GHEORGHE FTR ROMANA 27-Feb-1957 CONSTANTA 14531419 04-Nov-2018
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO 23-May-1967 ALTAVAS AKLAN EC2456794 17-Oct-2019
17 TALINIO, PETER BENABAYE Oiler FILIPINO 02-Jun-1976 DAVAO CITY EB7587403 07-Mar-2018
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO 18-Jan-1985 SAN JOSE ANTIQUE EC2615561 03-Nov-2019
19 BUTANAS, NOE COLITA Wiper FILIPINO 21-Nov-1985 DANGCAGAN BKN EB9523619 05-Nov-2018
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO 27-Apr-1985 MAKATO AKLAN EB8851797 02-Aug-2018
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO 28-Aug-1984 TARLAC TARLAC EB8103829 13-May-2018
22 CATALUA, JAMES ROBERT MASONG Deck Cadet FILIPINO 29-May-1995 CAG DE ORO CITY EC1126184 15-May-2019
22 ARRIVAL
MASTER Capt. TRUHN, UKASZ PATRYK
Master m/v LENA-S.
DATE OF ARRIVAL 16-Mar-2016 Wednesday
PORT OF ARRIVAL COLOMBO, SRI LANKA PORT ONLY
LAST PORT OF CALL SINGAPORE PORT ONLY
NEXT PORT OF CALL NEW YORK, U.S.A PORT ONLY
NAME OF AGENT Star lanka Shipping (Pvt) Ltd.
1 HONG KONG HKHKG - TMO ZIM Integrated Shipping Services (China) Co. Ltd. TMO- Modern Terminals Limited
2 DACHAN BAY, CNSAD - TDB ZIM Integrated Shipping Services (China) Co. Ltd. TDB- Dachan Terminal 1.
3 YAN TIAN, CNOJA - TYI China Merchants Ocean Shipping Agency TYI- Yantian Int'l Container Terminal
4 CAI MIP, VNTCT - TOT ZIM Vietnam LLC TCOT- Tan Cang-Cai Mep ODA Terminal
5 SINGAPORE, SGSIN - TPS Star Shipping Agencies (s) Pte Ltd. TPS- PSA Marine Terminal
6 COLOMBO, LKCMB - TSA Star lanka Shipping (Pvt) Ltd. TSA- South Asia Gateway-SAGT
7 SUEZ CANAL/ PORT SAID - EGSUZ EGYMAR Shipping Services Ltd. EGSUZ - Tramsit
8 NEW YORK - USNYC ZIM-AMERICAN Integrated Shipping Services Co., INC. TMT- Maher Terminal
9 SAVANNAH - USSAV ZIM-AMERICAN Integrated Shipping Services Co., INC. TPM- Portmouth Terminal
10 SAVANNAH - USSAV ZIM-AMERICAN Integrated Shipping Services Co., INC. TNI- Norfolk Int'l Terminal
SEAMAN"S BOOK ANTIGUA & BARBUDA VACCINATION Joining
Date & Place
US
Seaman's bk. Expire SBK Place Issued Antigua SBK Expiry Yellow fever Cholera TYPE foil number
0212403 UNLIMITED Gdynia 116834 22-Dec-2016 Jan-2024 18-Jan-2016 New York R C1/D 81334033
C0157405 11-Nov-2018 Manila 12-Mar-2016 Singapore R C1/D
C0348002 03-Feb-2020 Manila 12-Mar-2016 Singapore R C1/D
1923/2011 09-May-2021 Kotor Oct-2021 29-Feb-2016 Singapore R C1/D K4935574
MC0000470 30-Jun-2019 Estonia 51704 05-Jul-2020 Aug-2024 18-Jan-2016 New York R C1/D K1156006
C0770861 31-Jan-2021 65686 07-Feb-2017 Jun-2019 29-Feb-2016 Singapore R C1/D H2015054
B1260294 13-Nov-2017 Manila 12-Mar-2016 Singapore R C1/D
C0185463 14-Jan-2019 Manila Feb-2024 13-Dec-2015 Singapore R C1/D
C0375393 25-Jan-2020 Manila 12-Mar-2016 Singapore R C1/D
C0446522 25-May-2020 Manila May-2019 13-Dec-2015 Singapore R C1/D K6037005
C0170332 01-Dec-2018 Manila 12-Mar-2016 Singapore R C1/D
C0131007 03-Sep-2018 Manila 12-Mar-2016 Singapore R C1/D
C0057746 02-Apr-2018 Manila 115774 15-Nov-2016 Apr-2018 29-Jun-2015 Hong Kong R C1/D F0939553
C0333242 16-Oct-2019 Manila 12-Mar-2016 Singapore R C1/D
17398CT 01-Oct-2016 Constanta 69992 22-Feb-2017 Mar-2020 10-Oct-2015 Singapore R C1/D C5870943
C0171353 02-Dec-2018 Manila 12-Mar-2016 Singapore R C1/D
C0428913 05-Jul-2020 Manila 12-Mar-2016 Singapore R C1/D
C0308976 06-Nov-2019 Manila 12-Mar-2016 Singapore R C1/D
C0168520 15-Dec-2018 Cagayan de Oro 141706 13-Jan-2020 Apr-2020 29-Jun-2015 Hong Kong R C1/D K6042798
C0310052 18-Aug-2019 Manila Apr-2018 13-Dec-2015 Singapore R C1/D H8526069
C0056547 31-Mar-2018 Manila 137131 27-May-2019 Jun-2025 29-Jun-2015 Hong Kong R C1/D K6046919
C0217583 04-Jun-2019 Manila Oct-2024 13-Dec-2015 Singapore R C1/D K2979164

Container Terminal
Mep ODA Terminal
US VISA
control number EXPIRY DATE
20061703940001 18-Jun-2016
20153621100009 28-Dec-2018
20152025300001 20-Jul-2020
2013050209009 18-Feb-2018
20151387160008 17-May-2020
20112920140002 18-Oct-2016
20103135690001 09-Nov-2015
20151429080030 21-May-2020
20132537640017 09-Sep-2018
20151531180030 01-Jun-2020
20151042530014 13-Apr-2020
IMO CREW-LIST
(Passport)
Arrival Departure
1. Name of the ship 2. Port of Arrival / Departure 3. Date of Arrival / Departure
m/v "LENA-S." COLOMBO, SRI LANKA 16-Mar-2016

4. Nationality of the Ship 5. Port arrived from 6. Port of Destination
Antigua & Barbuda SINGAPORE NEW YORK, U.S.A

7.No 8. Family Name, Given Name 9. Rank 10. Sex 11. Nationality 12. Place of Birth 12a. Date of Birth 13. Passport No.. 13a. Expiry date
1 TRUHN, UKASZ PATRYK Master M POLISH GDYNIA 22-Feb-1983 AT4669451 19-Jan-2018
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. M FILIPINO MANDAUE CITY 2-May-1978 EB5029024 27-Mar-2017
3 TABANDA, RONALD BANO 2nd Off. M FILIPINO ILOILO CITY 4-Jun-1978 EC3387899 05-Feb-2020
4 ERANI, DAVOR 3rd Off. M MONTENEGRIN BERANE 19-Mar-1990 F84BZ5897 09-May-2021
5 FILIMONOV, PAVEL Ch. Engr. M ESTONIAN TALLIN 24-Nov-1961 KB0745160 20-Dec-2018
ANDA
6 CACHO, RUFINO CASTRENCE 2nd Eng. M FILIPINO 11-Mar-1974 EC6403068 13-Jan-2021
PANGASINAN
7 IBERA, MELCHOR GUZMAN 3rd Eng. M FILIPINO ILOCOS SUR 28-Nov-1970 EB7258820 30-Jan-2018
8 GRANADA, DIOSDADO MANGUBAT Electr. M FILIPINO MEDELLIN CEBU 7-Feb-1964 EC6116517 30-Nov-2020
9 HIDLAO, MICHAEL TUMAPON Bosun M FILIPINO DAPITAN CITY 1-Feb-1978 EB7231344 23-Jan-2018
HINUNANGAN S
10 ANG, JOVITO BALIAD A/B M FILIPINO 26-Jun-1969 EC4153790 11-May-2020
LTE
11 MERCADO, FREDERICK CORPUZ A/B M FILIPINO MANILA 18-Jan-1973 EC2864529 27-Nov-2019
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S M FILIPINO MANILA 18-Sep-1985 EC5478600 24-Sep-2020
HINIGARAN NEG
13 GENOSA, RYAN SEBONGA O/S M FILIPINO 29-May-1987 EC4212610 19-May-2020
OC
14 GARROVILLO, IAN ROY CORDOVA O/S M FILIPINO BACOLOD CITY 1-May-1984 EC2498528 21-Oct-2019
15 MARIN, GHEORGHE FTR M ROMANA CONSTANTA 27-Feb-1957 14531419 04-Nov-2018
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler M FILIPINO ALTAVAS AKLAN 23-May-1967 EC2456794 17-Oct-2019
17 TALINIO, PETER BENABAYE Oiler M FILIPINO DAVAO CITY 2-Jun-1976 EB7587403 07-Mar-2018
SAN JOSE
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper M FILIPINO 18-Jan-1985 EC2615561 03-Nov-2019
ANTIQUE
DANGCAGAN
19 BUTANAS, NOE COLITA Wiper M FILIPINO 21-Nov-1985 EB9523619 05-Nov-2018
BKN
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook M FILIPINO MAKATO AKLAN 27-Apr-1985 EB8851797 02-Aug-2018
21 AYAP, MARK ANGELO FULGENCIO Messman M FILIPINO TARLAC TARLAC 28-Aug-1984 EB8103829 13-May-2018
CAG DE ORO
22 CATALUA, JAMES ROBERT MASONG Deck Cadet M FILIPINO 29-May-1995 EC1126184 15-May-2019
CITY
13. Date and signature by master, authorized agent or officer
Capt. TRUHN, UKASZ PATRYK

Master m/v LENA-S.
I M O CREW-LI ST
Passport & Body Temperature
Arrival Departure
1. Name of the ship 2. Port of Arrival / Departure
m/v " LENA-S. " COLOMBO, SRI LANKA

4. Nationality of the Ship 5. Port arrived from
Antigua & Barbuda SINGAPORE

7.No 8. Family Name, Given Name 9. Rank 10. Sex 11. Nationality 12. Place of Birth
1 TRUHN, UKASZ PATRYK Master M POLISH GDYNIA
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. M FILIPINO MANDAUE CITY
3 TABANDA, RONALD BANO 2nd Off. M FILIPINO ILOILO CITY
4 ERANI, DAVOR 3rd Off. M MONTENEGRIN BERANE
5 FILIMONOV, PAVEL Ch. Engr. M ESTONIAN TALLIN
ANDA
6 CACHO, RUFINO CASTRENCE 2nd Eng. M FILIPINO
PANGASINAN
7 IBERA, MELCHOR GUZMAN 3rd Eng. M FILIPINO ILOCOS SUR
8 GRANADA, DIOSDADO MANGUBAT Electr. M FILIPINO MEDELLIN CEBU
9 HIDLAO, MICHAEL TUMAPON Bosun M FILIPINO DAPITAN CITY
HINUNANGAN S
10 ANG, JOVITO BALIAD A/B M FILIPINO
LTE
11 MERCADO, FREDERICK CORPUZ A/B M FILIPINO MANILA
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S M FILIPINO MANILA
HINIGARAN NEG
13 GENOSA, RYAN SEBONGA O/S M FILIPINO
OC
14 GARROVILLO, IAN ROY CORDOVA O/S M FILIPINO BACOLOD CITY
15 MARIN, GHEORGHE FTR M ROMANA CONSTANTA
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler M FILIPINO ALTAVAS AKLAN
17 TALINIO, PETER BENABAYE Oiler M FILIPINO DAVAO CITY
SAN JOSE
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper M FILIPINO
ANTIQUE
DANGCAGAN
19 BUTANAS, NOE COLITA Wiper M FILIPINO
BKN
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook M FILIPINO MAKATO AKLAN
21 AYAP, MARK ANGELO FULGENCIO Messman M FILIPINO TARLAC TARLAC
CAG DE ORO
22 CATALUA, JAMES ROBERT MASONG Deck Cadet M FILIPINO
CITY

IST
ture
3. Date of Arrival / Departure
16-Mar-2016
6. Port of Destination 18 Hrs before
NEW YORK, U.S.A 6 hrs. before

Body Temp.
12a. Date of Birth 13. Passport No.. 13a. Expiry date
22-Feb-1983 AT4669451 19-Jan-2018 35,8/ 35.7
2-May-1978 EB5029024 27-Mar-2017 36.5/36.2
4-Jun-1978 EC3387899 05-Feb-2020 35.6/35.8
19-Mar-1990 F84BZ5897 09-May-2021 36.2/35.9
24-Nov-1961 KB0745160 20-Dec-2018 35.7/35.8
11-Mar-1974 EC6403068 13-Jan-2021 35.6/35.8
28-Nov-1970 EB7258820 30-Jan-2018 36.2/35.9
7-Feb-1964 EC6116517 30-Nov-2020 35.6/35.7
1-Feb-1978 EB7231344 23-Jan-2018 35.5/35.6
26-Jun-1969 EC4153790 11-May-2020 35.8/35.7
18-Jan-1973 EC2864529 27-Nov-2019 35.8/35.6
18-Sep-1985 EC5478600 24-Sep-2020 35.6/35.6
29-May-1987 EC4212610 19-May-2020 35.5/35.6
1-May-1984 EC2498528 21-Oct-2019 36.0/35.8
27-Feb-1957 14531419 04-Nov-2018 36.0/35.9
23-May-1967 EC2456794 17-Oct-2019 35.6/35.7
2-Jun-1976 EB7587403 07-Mar-2018 35.7/35.6
18-Jan-1985 EC2615561 03-Nov-2019 35.6/35.7

21-Nov-1985 EB9523619 05-Nov-2018 35.8/35.6
27-Apr-1985 EB8851797 02-Aug-2018 35.7/35.6
28-Aug-1984 EB8103829 13-May-2018 36.2/35.9
29-May-1995 EC1126184 15-May-2019 36.0/35.9

Master m/v "LENA-S"
Crew List
IMO Convention on Facillitation
of international Maritime Traffic
(Name of shipping line,agent e.t.c. ) EgyMar Shipping
ZIM Integrated Shipping Services Ltd
1. Name of ship Page No. 1 2. Port of arrival 3. Date of arrival
m/v "LENA-S." 1 COLOMBO, SRI LANKA 3/16/2016

4. Nationality of ship 5. Port arrived from 6. Port of destination 7.Nature and No.of identity
Antigua & Barbuda SINGAPORE NEW YORK, U.S.A document

8.No. 9. Family name , given name , middle name 10.Rank or rating 11.Nationality 12. Date and place of birth Seaman's
Passport
Book
1 TRUHN, UKASZ PATRYK Master POLISH 22-Feb-1983 GDYNIA 0212403 AT4669451

2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO 2-May-1978 MANDAUE CITY C0157405 EB5029024
3 TABANDA, RONALD BANO 2nd Off. FILIPINO 4-Jun-1978 ILOILO CITY C0348002 EC3387899
4 ERANI, DAVOR 3rd Off. MONTENEGRIN 19-Mar-1990 BERANE 1923/2011 F84BZ5897
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN 24-Nov-1961 TALLIN MC0000470 KB0745160
6 CACHO, RUFINO CASTRENCE 2nd Eng. FILIPINO 11-Mar-1974 ANDA PANGASINAN C0770861 EC6403068
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO 28-Nov-1970 ILOCOS SUR B1260294 EB7258820
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO 7-Feb-1964 MEDELLIN CEBU C0185463 EC6116517
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO 1-Feb-1978 DAPITAN CITY C0375393 EB7231344
10 ANG, JOVITO BALIAD A/B FILIPINO 26-Jun-1969 HINUNANGAN S LTE C0446522 EC4153790
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO 18-Jan-1973 MANILA C0170332 EC2864529
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO 18-Sep-1985 MANILA C0131007 EC5478600
13 GENOSA, RYAN SEBONGA O/S FILIPINO 29-May-1987 HINIGARAN NEG OC C0057746 EC4212610
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO 1-May-1984 BACOLOD CITY C0333242 EC2498528
15 MARIN, GHEORGHE FTR ROMANA 27-Feb-1957 CONSTANTA 17398CT 14531419
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO 23-May-1967 ALTAVAS AKLAN C0171353 EC2456794
17 TALINIO, PETER BENABAYE Oiler FILIPINO 2-Jun-1976 DAVAO CITY C0428913 EB7587403
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO 18-Jan-1985 SAN JOSE ANTIQUE C0308976 EC2615561
19 BUTANAS, NOE COLITA Wiper FILIPINO 21-Nov-1985 DANGCAGAN BKN C0168520 EB9523619
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO 27-Apr-1985 MAKATO AKLAN C0310052 EB8851797
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO 28-Aug-1984 TARLAC TARLAC C0056547 EB8103829
22 CATALUA, JAMES ROBERT MASONG Deck Cadet FILIPINO 29-May-1995 CAG DE ORO CITY C0217583 EC1126184
23
24
25
26
27
12. Date and signature by Master, authorized agent or officer
I M O PASSENGER - LIST
(PASSPORT )
Page No.
Arrival Departure 1

7.No 8. Family Name, Given Name 9. Nationality 10. Sex 11. Rank 11. Date of Birth 11a. Place of Birth 12. No.of identity doc. 12a. Expiry date
10
11
12
13
14
15
16
17
18
19

Master m/v LENA-S.
IMO CREW'S EFFECTS DECLARATION
ARRIVAL DEPARTURE


2. Effects which are dutiable or subject to prohibitation
4. No. 5. Family name, given names 6. Rank or rating cigarette spirits wine Beer Personal belongings 7. Signature
1 Mobile Phone & Charger

1 TRUHN, UKASZ PATRYK Master - - - - 3 Ext.Hard Drives, 2 Wrist Watches,
1 Gold ring, 1 Electric Toothbrush
Personal Effects.
HEYROSA, DARIUS - - - -
2 Ch. Off.
MARTINQUILLA
3 TABANDA, RONALD BANO 2nd Off. - - - -
1 Laptop, 1 Cellphone, 1 USB,

Personal effects
4 ERANI, DAVOR 3rd Off. - - - -
1 Tablet, 2 Cellphones
5 FILIMONOV, PAVEL Ch. Engr. - - - - 2 Wrist watch, 1Shaver, 1 blood press. tester,
1 Sugar tester, 5 pcs. USB,
Personal Effects and medicines.
1 Laptop, 1 Cellphone,
6 CACHO, RUFINO CASTRENCE 2nd Eng. - - - - Personal effects.
7 IBERA, MELCHOR GUZMAN 3rd Eng. - - - -
1 Tablet, 2 Cellphones, 1 Wrist Watch, 1 USB

8 GRANADA, DIOSDADO MANGUBA Electr. - - - - 3 Pairs of reading glasses, personal effects
1 Plus Light
9 HIDLAO, MICHAEL TUMAPON Bosun - - - -
1 Laptop, 1 Hard Disk, Hair Clipper

- - - - Personal Effects
10 ANG, JOVITO BALIAD A/B
MERCADO, FREDERICK - - - -
11 A/B
CORPUZ
DEOCAMPO, RODOLFO JR. - - - -

12 O/S
HERMOSA
1 Laptop, 1Tablet, 3 Mobile Phones,

13 GENOSA, RYAN SEBONGA O/S 2 Hard Drive, 1Set Speaker, 2 Wrist Watch
- - - - 2 USB, Personal Effects
17/44
ARRIVAL DEPARTURE


GARROVILLO, IAN ROY - - - -

14 O/S
CORDOVA
1 Laptop, 2 Mobile Phones,

15 MARIN, GHEORGHE FTR 1 Hard drive, 1 Wrist watch,
- - - - 1 USB, 1 Alarm Clock,
1 Speaker, Personal Effects.
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler - - - -
17 TALINIO, PETER BENABAYE Oiler - - - -
CASALAN, CHARLE MAGNE - - - -

18 Wiper
MAGBANUA
1 Mobile Phone, 1 I Pod w/Charger,

19 BUTANAS, NOE COLITA Wiper - - - - 1 Nikon Camera
Personal Effects
1 Ipod, 1 Cellphone, 1 Wrist Watch, 1 Hdd,

20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook - - - - 1 pair reading glasses,1 Laptop
AYAP, MARK ANGELO 1 I pod, 3 Mobile Phones, 2 USB,

21 Messman - - - - 2 Wrist Watch, 1 Gold Ring,
FULGENCIO
1 Portable Speaker, Personal Effects.
1 Laptop, 1 Cellphone, 2 Wrist watch,

CATALUA, JAMES ROBERT - - - - Reading glasses, 1 Headset, 1USB,
22 Deck Cadet
MASONG Personal effects
16/03/2016 Capt. TRUHN, UKASZ PATRYK

Master m/v LENA-S.
18/44
ARRIVAL DEPARTURE


19/44
1. Name of the ship

P ARRIVAL DEPARTURE
2. Port of Arrival / Departure 3. Date of Arrival / Departure


1 CHOI, JUNNYEONG Tehnician Personal effects
2 CHOI, SEUNGHO Tehnician Personal effects
4 0 Passenger _ _ _ _ PERSONAL EFFECTS
10
11
12
16/03/2016 Capt. TRUHN, UKASZ PATRYK

Master m/v LENA-S.
20/44
SHIP'S STORE LIST
Name of ship Port of arrival Date of arrival

Nationality of ship Port arrived from Next port of call

Name of Master Name of agent Number of crew / passenger
Capt. TRUHN, UKASZ PATRYK Star lanka Shipping (Pvt) Ltd. 22

DECK ENGINE
Paint 2,031 ltrs. Heavy Fuel MT
Paint Thinner 210 ltrs. Marine Diesel Oil 81.0 MT
Paint Brush 82 pcs. Assorted Lub Oil MT
Paint Roller 135 pcs. Fresh water MT
Kerosene and solvent NIL ltrs. Ballast Water MT
Grease 40 kgs. Assorted chemicals ltrs
Chemicals / Rust remover 40 ltrs. Grease kg
Washing Powder (detergent and soap) 80 ltrs.
Cement 40 kgs. *And all other tools equipments,materials according to
Manila Ropes 150 mtrs. inventory list delivery notes,etc. which neccessary
Mooring Ropes 3,300 mtrs. for proper handling and maintenance of the vessel.
Nylonpoly Ropes 220 mtrs.
Tarpaulines 10 mtrs. PROVISION AND CATERING LIST
Lashing wires/ Rope wires 80 mtrs.
Computer & Monitor 10 pcs. Meat ( fresh/frozen/dried/salt ) kgs.
Printer 12 pcs. Poultry kgs.
Photocopy Machine 2 pcs. Potatoes kgs.
Table Tennis 1 set Rice kgs.
Vacuum Cleaner 2 pcs. Flour kgs.
Refrigerator 33 unit Butter/Margarine kgs.
Washing Machine + Drier Machine 5+5 unit Cheese kgs.
Flat Iron & stand 2 pcs. Sugar kgs.
Bread Toaster 2 pcs. Coffee kgs.
Rice Cooker + Elect. Hot plate 1 + 1 pc. Tea kg.
Coffee Maker + Water Heater 5+3 pcs. Cocoa grms.
Radio stereo (music) 5 pcs. Bread loaf
Television 8 pcs. Cereals kgs.
Vhs Player + DVD Player 6 pcs. Assorted Juice ltrs.
Scanner + Laminator Machine 4+1 set Jam Honey btls.
Training bicycle + Gymnasium 1 set Noodles/Spaghetti kgs.
Table calculator 7 pc Vegetables ( fresh/canned ) kgs.
*And all other tools equipments,materials according to Milk ltrs.
inventory list delivery notes,etc.which neccessary Evaporated Milk tins
for proper handling and maintenance of the vessel Fruits ( fresh/dried/canned ) kgs.
and for the crew members use. Fresh EGGS pcs.
SAFETY NAVIGATIONAL EQUIPMENTS Fish ( fresh/frozen/salt ) kgs.
Lifeboat (1 AS A RESCUE BOAT) 2 set Cooking Oil ltrs.
Lifejackets 41 set Dairy Kgs
Line Throwing Apparatus + rockets 4 set 20 pcs.
Distress Signal Total 48 pcs. And hereby declare all other quantities of provision
Orange Smoke Signal 4 pcs. and foodstuffs which are required for normal and
Binocular 3 pcs. daily preparation of foods and meals of the crew
Walkie Talkie + spare bat. + charger 20 set also all other equipments ,materials, utinsels,tools
Digital Camera + Charger 2 set inside the galley,messrooms,pantry and storerooms
GMDSS Radio + spare bat. + charger (prtbl.) 3 set according to inventory list delivery notes etc.which
Radar + GPS+ECDIS 2+2+2 set are necessary for proper handling of the vessel.
Sat C + Sat F Phone + F Fax 2 +1+1 set
Facsimile + Navtex 1+1 set
Mobile Phone + Bat. Charger 1 set
PORT OF CALL LIST
1. Name of Ship: 2. Port of Arrival / Departure 3. Date of Arrival / Departure
m/v "LENA-S." COLOMBO, SRI LANKA 16-March-2016

4. Nationality 5. PORT ARRIVED FROM 6. PORT DESTINATION

7. Registration (Port,No.) 8. Master's Name 9. Local Agent
St. John's (4586) Capt. TRUHN, UKASZ PATRYK Star lanka Shipping (Pvt) Ltd.
Security
Port Country level Arrival Date Departure Date
1 SINGAPORE SINGAPORE 1 12-Mar-2016 12-Mar-2016
2 CAI MEP VIETNAM 1 10-Mar-2016 10-Mar-2016
3 YANTIAN CHINA 1 07-Mar-2016 07-Mar-2016
4 DA CHAN BAY CHINA 1 06-Mar-2016 06-Mar-2016
5 SINGAPORE SINGAPORE 1 29-Feb-2016 01-Mar-2016
6 NORFOLK U.S.A 1 25-Jan-2016 25-Jan-2016
7 SAVANNAH U.S.A 1 22-Jan-2016 23-Jan-2016
8 NEW YORK U.S.A 1 19-Jan-2016 20-Jan-2016
9 SUEZ (TRANSIT) EGYPT 1 06-Jan-2016 07-Jan-2016
10 COLOMBO SRI LANKA 1 29-Dec-2015 29-Dec-2015

Master m/v LENA-S.
PORT OF CALL LIST
1. Name of Ship: 2. Port of Arrival/Departure 3. Date of Arrival/Departure


St. John (4586) Capt. TRUHN, UKASZ PATRYK Star lanka Shipping (Pvt) Ltd.
Security
484 BALBOA PANAMA 1 04-Jan-2015 04-Jan-2015

485 PANAMA CANAL(Transit) PANAMA 1 05-Jan-2015 05-Jan-2015
486 MANZANILLO PANAMA 1 05-Jan-2015 06-Jan-2015
487 JACKSONVILLE U.S.A. 1 09-Jan-2015 09-Jan-2015
488 NEW YORK U.S.A. 1 12-Jan-2015 12-Jan-2015
489 PHILADELPHIA U.S.A. 1 14-Jan-2015 14-Jan-2015
490 CHARLESTON U.S.A. 1 17-Jan-2015 17-Jan-2015
491 MIAMI U.S.A. 1 19-Jan-2015 19-Jan-2015
492 MANZANILLO PANAMA 1 23-Jan-2015 23-Jan-2015
493 PANAMA CANAL(Transit) PANAMA 1 24-Jan-2015 24-Jan-2015
494 BALBOA PANAMA 1 24-Jan-2015 25-Jan-2015
495 BUENAVENTURA COLOMBIA 1 26-Jan-2015 26-Jan-2015
496 CALLAO PERU 1 31-Jan-2015 01-Feb-2015
497 VALPARAISO CHILE 1 04-Feb-2015 05-Feb-2015
498 CALLAO PERU 1 08-Feb-2015 08-Feb-2015
499 PAITA PERU 1 10-Feb-2015 10-Feb-2015
500 BUENAVENTURA COLOMBIA 1 13-Feb-2015 14-Feb-2015
501 BALBOA PANAMA 1 15-Feb-2015 16-Feb-2015
502 PANAMA CANAL(Transit) PANAMA 1 16-Feb-2015 16-Feb-2015
503 MANZANILLO PANAMA 1 16-Feb-2015 17-Feb-2015
504 JACKSONVILLE U.S.A. 1 20-Feb-2015 20-Feb-2015
505 NEW YORK U.S.A. 1 23-Feb-2015 23-Feb-2015
506 PHILADELPHIA U.S.A. 1 25-Feb-2015 25-Feb-2015
507 CHARLESTON U.S.A. 1 28-Feb-2015 28-Feb-2015
508 MIAMI U.S.A. 1 02-Mar-2015 02-Mar-2015
509 MANZANILLO PANAMA 1 06-Mar-2015 06-Mar-2015
510 PANAMA CANAL(Transit) PANAMA 1 07-Mar-2015 07-Mar-2015
511 BALBOA PANAMA 1 07-Mar-2015 08-Mar-2015
512 BUENAVENTURA COLOMBIA 1 09-Mar-2015 10-Mar-2015
513 CALLAO PERU 1 14-Mar-2015 15-Mar-2015
514 VALPARAISO CHILE 1 18-Mar-2015 19-Mar-2015
515 CALLAO PERU 1 22-Mar-2015 22-Mar-2015
516 BUENAVENTURA COLOMBIA 1 27-Mar-2015 28-Mar-2015
517 BALBOA PANAMA 1 29-Mar-2015 29-Mar-2015
518 MANZANILLO PANAMA 1 30-Mar-2015 31-Mar-2015
519 JACKSONVILLE U.S.A. 1 03-Apr-2015 04-Apr-2015
520 NEW YORK U.S.A. 1 06-Apr-2015 07-Apr-2015
521 PHILADELPHIA U.S.A. 1 08-Apr-2015 09-Apr-2015
522 CHARLESTON U.S.A. 1 11-Apr-2015 11-Apr-2015
523 MIAMI U.S.A. 1 13-Apr-2015 13-Apr-2015
Page 23 of 44
PORT OF CALL LIST


Security
524 MANZANILLO PANAMA 1 17-Apr-2015 18-Apr-2015

525 PANAMA CANAL(Transit) PANAMA 1 19-Apr-2015 19-Apr-2015
526 DUTCH HARBOR ALASKA U.S.A. 1 556/2015 11-May-2015
527 PUSAN SOUTH KOREA 1 18-May-2015 19-May-2015
528 QINGDAO CHINA 1 20-May-2015 21-May-2015
529 QINGDAO CHINA 1 23-May-2015 24-May-2015
530 SHANGHAI CHINA 1 26-May-2015 27-May-2015
531 NINGBO CHINA 1 29-May-2015 29-May-2015
532 CHIWAN CHINA 1 31-May-2015 31-May-2015
533 SINGAPORE-spa SINGAPORE 1 04-Jun-2015 04-Jun-2015
534 PORT KLANG MALAYSIA 1 05-Jun-2015 05-Jun-2015
535 KARACHI PAKISTAN 1 12-Jun-2015 16-Jun-2015
536 COLOMBO SRI LANKA 1 19-Jun-2015 20-Jun-2015
537 SINGAPORE SINGAPORE 1 24-Jun-2015 25-Jun-2015
538 HONG KONG CHINA 1 29-Jun-2015 30-Jun-2015
539 QINGDAO CHINA 1 04-Jul-2015 04-Jul-2015
540 QINGDAO-Beihai Shipyard CHINA 1 04-Jul-2015 16-Jul-2015
541 DA CHAN BAY CHINA 1 24-Jul-2015 25-Jul-2015
542 YANTIAN CHINA 1 25-Jul-2015 26-Jul-2015
543 CAI MEP VIETNAM 1 28-Jul-2015 28-Jul-2015
544 SINGAPORE SINGAPORE 1 30-Jul-2015 31-Jul-2015
545 COLOMBO SRI LANKA 1 04-Aug-2015 04-Aug-2015
546 SUEZ CANAL (transit) EGYPT 1 12-Aug-2015 13-Aug-2015
547 NEW YORK U.S.A 1 24-Aug-2015 26-Aug-2015
548 SAVANNAH U.S.A 1 28-Aug-2015 29-Aug-2015
549 NORFOLK U.S.A 1 31-Aug-2015 31-Aug-2015
550 SUEZ CANAL (transit) EGYPT 1 14-Sep-2015 15-Sep-2015
551 SINGAPORE SINGAPORE 1 28-Sep-2015 28-Sep-2015
552 DA CHAN BAY CHINA 1 03-Oct-2015 03-Oct-2015
553 YANTIAN CHINA 1 05-Oct-2015 06-Oct-2015
554 CAI MEP VIETNAM 1 08-Oct-2015 08-Oct-2015
555 SINGAPORE SINGAPORE 1 10-Oct-2015 10-Oct-2015
556 COLOMBO SRI LANKA 1 14-Oct-2015 15-Oct-15
556 NEW YORK U.S.A 1 03-Nov-2015 4-Nov-15
556 SAVVANAH U.S.A 1 06-Nov-2015 7-Nov-15
556 NORFOLK U.S.A 1 09-Nov-2015 9-Nov-15
557 SUEZ CANAL (transit) EGYPT 1 27-Nov-2015 29-Nov-15
558 SINGAPORE SINGAPORE 1 13-Dec-2015 14-Dec-15
560 DA CHAN BAY CHINA 1 18-Dec-2015 19-Dec-15
Page 24 of 44
PORT OF CALL LIST


Security
561 YANTIAN CHINA 1 19-Dec-2015 20-Dec-2015

562 CAI MEP VIETNAM 1 22-Dec-2015 23-Dec-2015
564 COLOMBO SRI LANKA 1 29-Dec-2015 29-Dec-2015
565 SUEZ (TRANSIT) EGYPT 1 06-Jan-2016 07-Jan-2016
566 NEW YORK U.S.A 1 19-Jan-2016 20-Jan-2016
567 SAVANNAH U.S.A 1 22-Jan-2016 23-Jan-2016
568 NORFOLK U.S.A 1 25-Jan-2016 25-Jan-2016

Master m/v LENA-S.
Page 25 of 44
MARITIME DECLARATION OF HEALTH
To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports.
Submitted at the port of: COLOMBO, SRI LANKA Date: 12-March-2016
Name of ship or inland navigation vessel: m/v "LENA-S." Registration/IMO No.: 9 431 757
arriving from: SINGAPORE sailing to: NEW YORK, U.S.A
(Nationality)(Flag of vessel): Antigua & Barbuda Masters name : Capt. TRUHN, UKASZ PATRYK
Gross tonnage (ship): 40,541
Tonnage (inland navigation vessel):
Valid Sanitation Control Exemption/Control Certificate carried on board? yes no Issued at: Colombo, Sri Lanka
Date: 29-Dec-2015
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 thirty (30) days, whichever is shorter:
- SEE ATTACHED PORTS OF CALLS LIST -
Upon request of the 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, whichever is shorter, including all ports/countries visit.
-(1) Names ERANI, DAVOR (1) joined from SINGAPORE (1) Date: 29-02-2016
-(2) Names CACHO, RUFINO CASTRENCE (2) joined from SINGAPORE (2) Date: 29-02-2016
-(3) Names HEYROSA, DARIUS MARTINQUILLA (3) joined from SINGAPORE (3) Date: 12-03-2016
-(4) Names TABANDA, RONAL BANO (4) joined from SINGAPORE (4) Date: 12-03-2016
-(5) Names IBERA, MELCHOR GUZMAN (5) joined from SINGAPORE (5) Date: 12-03-2016
-(6) Names HIDLAO, MICHAEL TUMAPON (6) joined from SINGAPORE (6) Date: 12-03-2016
-(7) Names MERCADO, FREDERICK CORPU (7) joined from SINGAPORE (7) Date: 12-03-2016
-(8) Names DEOCAMPO, RODOLFO JR. HERMOSA (8) joined from SINGAPORE (8) Date: 12-03-2016
-(9) Names GARROVILLO, IAN ROY CORDOVA (9) joined from SINGAPORE (9) Date: 12-03-2016
-(10) Names LIBO-ON, ALBERTO JR. ONAYAN (10) joined from SINGAPORE (10) Date: 12-03-2016
-(11) Names TALINIO, PETER BENABAYE (10) joined from SINGAPORE (10) Date: 12-03-2016
-(12) Names CASALAN, CHARLE MAGNE MAGBANUA(10) joined from SINGAPORE (10) Date: 12-03-2016
Number of crew members onboard: 22 Number of passengers onboard: NIL
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. Total no. of deaths: none
(2) Is there on board or has there been during the international voyage any case of disease which you suspect to be of an infectious nature?
yes no 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? none
(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 a sick animal or pet on board? yes no
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.
Master Countersigned: Capt. TRUHN, UKASZ PATRYK 12-March-2016

Master m/v LENA-S.
ATTACHMENT TO MARITIME DECLARATION OF HEALTH
Class or Port, date joined Nature of Date of onset of Reported to a port Disposal of
Name Age Sex Nationality case*
rating ship/vessel illness symptoms medical officer?
NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL
Ships Surgeon (if carried) Date:
VACCINATION LIST
(Yellow Fever)
ARRIVAL DEPARTURE
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

4. Nationality of ship 5. Port arrived from 6. Port of Destination

7. No 8. Family name; given names 9. Rank 10. Nationality 11. Expiry date 12.Remarks
1 TRUHN, UKASZ PATRYK Master POLISH Jan-2024
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO Dec-1899
3 TABANDA, RONALD BANO 2nd Off. FILIPINO Dec-1899
4 ERANI, DAVOR 3rd Off. MONTENEGRIN Oct-2021
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN Aug-2024
6 CACHO, RUFINO CASTRENCE 2nd Eng. ROMANIAN Jun-2019
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO Dec-1899
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO Feb-2024
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO Dec-1899
10 ANG, JOVITO BALIAD A/B FILIPINO May-2019
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO Dec-1899
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO Dec-1899
13 GENOSA, RYAN SEBONGA O/S FILIPINO Apr-2018
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO Dec-1899
15 MARIN, GHEORGHE FTR ROMANA Mar-2020
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO Dec-1899
17 TALINIO, PETER BENABAYE Oiler FILIPINO Dec-1899
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO Dec-1899
19 BUTANAS, NOE COLITA Wiper FILIPINO Apr-2020
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO Apr-2018
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO Jun-2025
22 CATALUA, JAMES ROBERT MASONG Deck Cadet FILIPINO Oct-2024

Master m/v LENA-S.
NARCOTIC DECLARATION
ARRIVAL DEPARTURE

4. Nationality 5. PORT ARRIVED FROM 6. PORT OF DESTINATION

Below listed Narcotics are part of vessel's Medicine stock, and

stored under Master's custody or in Hospital's refrigerator.
m. code Name: Quantity: Expiration:
01.01 Codeine 20 pcs/ 30mg tab. 05/2017
06.01 Zolpidem 10 tabs/ 5mg tab. 07/2017
06.02 Diazepam 60 pcs/ 5mg tab. 09/2018
27.10 Diazepam suppository 5 pcs/ 10mg supp. 01/2018
27.17 Morphin Merck 40 amp/ 10mg amp. 12/2016
05.08 Tramadol hydrochloride 10 amp/ 50mg/2ml 03/2019
06.03 Sedative,Tranquillizer
Sleeping-pills (Diazepam) 10amp / 10mg/2ml 02/2017

Master m/v LENA-S.
N I L - LIST
ARRIVAL DEPARTURE
1. Name of Ship: 2. Port of Arrival / Departure 3. Date of Arrival / Departure


PASSENGERS ON BOARD = NIL
MAIL & PARCELS = NIL
STOWAWAYS ON BOARD = NIL
ANIMALS ON BOARD = NIL
ARMS AND AMMUNITIONS ON BOARD = NIL
DRUGS ( OTHER THAN SPECIFIED IN MEDICAL - = NIL

NARCOTIC DECLARATION )

Master m/v LENA-S.
CREW CURRENCY DECLARATION
1. Name of ship
ARRIVAL
2. Port of arrival/departure
DEPARTURE
3. Date of arrival/departure

4. Nationality of ship 5. Port arrived from 6. Port of Destination

7. No 8. Family name; given names 9. Rank 10. Nationality 11. US dollar 12. Other Currencies 13.Signatures
1 TRUHN, UKASZ PATRYK Master POLISH
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO
3 TABANDA, RONALD BANO 2nd Off. FILIPINO
4 ERANI, DAVOR 3rd Off. MONTENEGRIN
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN
6 CACHO, RUFINO CASTRENCE 2nd Eng. ROMANIAN
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO
10 ANG, JOVITO BALIAD A/B FILIPINO
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO
13 GENOSA, RYAN SEBONGA O/S FILIPINO
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO
15 MARIN, GHEORGHE FTR ROMANA
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO
17 TALINIO, PETER BENABAYE Oiler FILIPINO
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO
19 BUTANAS, NOE COLITA Wiper FILIPINO
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO
22 CATALUA, JAMES ROBERT MASONG Deck Cadet FILIPINO
Ship's Cash Box

Master m/v LENA-S.
ARMS AND AMMUNITIONS LIST
X ARRIVAL DEPARTURE


ARMS AND AMMUNITIONS ON BOARD = NIL

Master m/v LENA-S.
Bonded Store Declaration
ARRIVAL DEPARTURE

7. Item - No. 8. Article 9. In stock Total PCS
1 Cigarettes 47 crtns Cigarettes 9400
btls. by 1,0 l Total ltrs

7.5
2 Wine 10 btls. by 0,75 l
btls. by 0,70 l Total btls. 10

btls. by 0,9651
Total ltrs. 0.0
Spirits all kind 0 btls. by 1,0 l
3
0 btls. by 0,75 l
Total btls. 0
btls. by 0,70 l
Mineral 12 cs 12 x 1.5 ltrs
4 & cs 12 x 1.5 ltrs Total ltrs 216
Table Water cs 6 x 2.0 ltrs
18 Orange
Softdrinks 18 Sprite
5 17 7 UP
Total ltrs. 578.2
20 Coke & Pepsi
24 x 0.355 ltrs
6 Beer 15 24 x 0.330 ltrs Total ltrs. 118.8
12 x 0.600 ltr

Master m/v LENA-S.
FORM 22
IMMIGRATION ACT
(CHAPTER 133)
IMMIGRATION REGULATIONS
Name/ No. of Vessel: m/v "LENA-S." Master/Owner/Charterer: Capt. TRUHN, UKASZ PATRYK
Agents in Singapore: Star lanka Shipping (Pvt) Ltd. Date of Arrival: 16-Mar-2016
Last place of embarkation: SINGAPORE Date of proposed departure: 12-Mar-2016
Next destination: NEW YORK, U.S.A
Call sign: V2EC7
Expiry Date of
Travel
No. Name Sex Date of Birth Nationality Travel Rank
Documents No.
Document
1 TRUHN, UKASZ PATRYK M 22/Feb/83 POLISH AT4669451 19/Jan/18 Master
2 HEYROSA, DARIUS MARTINQUILLA M 2/May/78 FILIPINO EB5029024 27/Mar/17 Ch. Off.
3 TABANDA, RONALD BANO M 4/Jun/78 FILIPINO EC3387899 5/Feb/20 2nd Off.
4 ERANI, DAVOR M 19/Mar/90 MONTENEGRINF84BZ5897 9/May/21 3rd Off.
5 FILIMONOV, PAVEL M 24/Nov/61 ESTONIAN KB0745160 20/Dec/18 Ch. Engr.
6 CACHO, RUFINO CASTRENCE M 11/Mar/74 FILIPINO EC6403068 13/Jan/21 2nd Eng.
7 IBERA, MELCHOR GUZMAN M 28/Nov/70 FILIPINO EB7258820 30/Jan/18 3rd Eng.
8 GRANADA, DIOSDADO MANGUBAT M 7/Feb/64 FILIPINO EC6116517 30/Nov/20 Electr.
9 HIDLAO, MICHAEL TUMAPON M 1/Feb/78 FILIPINO EB7231344 23/Jan/18 Bosun
10 ANG, JOVITO BALIAD M 26/Jun/69 FILIPINO EC4153790 11/May/20 A/B
11 MERCADO, FREDERICK CORPUZ M 18/Jan/73 FILIPINO EC2864529 27/Nov/19 A/B
12 DEOCAMPO, RODOLFO JR. HERMOSA M 18/Sep/85 FILIPINO EC5478600 24/Sep/20 O/S
13 GENOSA, RYAN SEBONGA M 29/May/87 FILIPINO EC4212610 19/May/20 O/S
14 GARROVILLO, IAN ROY CORDOVA M 1/May/84 FILIPINO EC2498528 21/Oct/19 O/S
15 MARIN, GHEORGHE M 27/Feb/57 ROMANA 14531419 4/Nov/18 FTR
16 LIBO-ON, ALBERTO JR. ONAYAN M 23/May/67 FILIPINO EC2456794 17/Oct/19 Oiler
17 TALINIO, PETER BENABAYE M 2/Jun/76 FILIPINO EB7587403 7/Mar/18 Oiler
18 CASALAN, CHARLE MAGNE MAGBANUA M 18/Jan/85 FILIPINO EC2615561 3/Nov/19 Wiper
19 BUTANAS, NOE COLITA M 21/Nov/85 FILIPINO EB9523619 5/Nov/18 Wiper
20 JULIAN, JUNMAR DE LA CRUZ M 27/Apr/85 FILIPINO EB8851797 2/Aug/18 Ch. Cook
21 AYAP, MARK ANGELO FULGENCIO M 28/Aug/84 FILIPINO EB8103829 13/May/18 Messman
22 CATALUA, JAMES ROBERT MASONG M 29/May/95 FILIPINO EC1126184 15/May/19 Deck Cadet
I CERTIFY THAT ABOVE INFORMATION IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF TRUE IN EVERY
PARTICULAR.
Dated this 16th day of March 2016 MASTER/OWNER/CHARTERER/AGENT

US VISA VALIDITY
Name of ship
m/v "LENA-S."
Nationality of ship
Antigua & Barbuda US VISA

No. Family name; given names Rank or rating Nationality TYPE FOIL NUMBER CONTROL NUMBER EXPIRY DATE
1 TRUHN, UKASZ PATRYK Master POLISH R C1/D 81334033 20061703940001 18 Jun 2016
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO R C1/D 0 0 30 Dec 1899
3 TABANDA, RONALD BANO 2nd Off. FILIPINO R C1/D 0 0 30 Dec 1899
4 ERANI, DAVOR 3rd Off. MONTENEGRINR C1/D K4935574 20153621100009 28 Dec 2018
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN R C1/D K1156006 20152025300001 20 Jul 2020
6 CACHO, RUFINO CASTRENCE 2nd Eng. FILIPINO R C1/D H2015054 2013050209009 18 Feb 2018
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO R C1/D 0 0 30 Dec 1899
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO R C1/D 0 0 30 Dec 1899
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO R C1/D 0 0 30 Dec 1899
10 ANG, JOVITO BALIAD A/B FILIPINO R C1/D K6037005 20151387160008 17 May 2020
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO R C1/D 0 0 30 Dec 1899
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO R C1/D 0 0 30 Dec 1899
13 GENOSA, RYAN SEBONGA O/S FILIPINO R C1/D F0939553 20112920140002 18 Oct 2016
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO R C1/D 0 0 30 Dec 1899
15 MARIN, GHEORGHE FTR ROMANA R C1/D C5870943 20103135690001 09 Nov 2015
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO R C1/D 0 0 30 Dec 1899
17 TALINIO, PETER BENABAYE Oiler FILIPINO R C1/D 0 0 30 Dec 1899
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO R C1/D 0 0 30 Dec 1899
19 BUTANAS, NOE COLITA Wiper FILIPINO R C1/D K6042798 20151429080030 21 May 2020
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO R C1/D H8526069 20132537640017 09 Sep 2018
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO R C1/D K6046919 20151531180030 01 Jun 2020
22 CATALUA, JAMES ROBERT MASONG Deck Cadet FILIPINO R C1/D K2979164 20151042530014 13 Apr 2020

1 TRUHN, UKASZ PATRYK 1 TRUHN, UKASZ PATRYK 1 TRUHN, UKASZ PATRYK
2 HEYROSA, DARIUS MARTINQUILLA 2 HEYROSA, DARIUS MARTINQUILLA 2 HEYROSA, DARIUS MARTINQUILLA
3 TABANDA, RONALD BANO 3 TABANDA, RONALD BANO 3 TABANDA, RONALD BANO
4 ERANI, DAVOR 4 ERANI, DAVOR 4 ERANI, DAVOR
5 FILIMONOV, PAVEL 5 FILIMONOV, PAVEL 5 FILIMONOV, PAVEL
6 CACHO, RUFINO CASTRENCE 6 CACHO, RUFINO CASTRENCE 6 CACHO, RUFINO CASTRENCE
7 IBERA, MELCHOR GUZMAN 7 IBERA, MELCHOR GUZMAN 7 IBERA, MELCHOR GUZMAN
8 GRANADA, DIOSDADO MANGUBAT 8 GRANADA, DIOSDADO MANGUBAT 8 GRANADA, DIOSDADO MANGUBAT
9 HIDLAO, MICHAEL TUMAPON 9 HIDLAO, MICHAEL TUMAPON 9 HIDLAO, MICHAEL TUMAPON
10 ANG, JOVITO BALIAD 10 ANG, JOVITO BALIAD 10 ANG, JOVITO BALIAD
11 MERCADO, FREDERICK CORPUZ 11 MERCADO, FREDERICK CORPUZ 11 MERCADO, FREDERICK CORPUZ
12 DEOCAMPO, RODOLFO JR. HERMOSA 12 DEOCAMPO, RODOLFO JR. HERMOSA 12 DEOCAMPO, RODOLFO JR. HERMOSA
13 GENOSA, RYAN SEBONGA 13 GENOSA, RYAN SEBONGA 13 GENOSA, RYAN SEBONGA
14 GARROVILLO, IAN ROY CORDOVA 14 GARROVILLO, IAN ROY CORDOVA 14 GARROVILLO, IAN ROY CORDOVA
15 MARIN, GHEORGHE 15 MARIN, GHEORGHE 15 MARIN, GHEORGHE
16 LIBO-ON, ALBERTO JR. ONAYAN 16 LIBO-ON, ALBERTO JR. ONAYAN 16 LIBO-ON, ALBERTO JR. ONAYAN
17 TALINIO, PETER BENABAYE 17 TALINIO, PETER BENABAYE 17 TALINIO, PETER BENABAYE
18 CASALAN, CHARLE MAGNE MAGBANUA 18 CASALAN, CHARLE MAGNE MAGBANUA 18 CASALAN, CHARLE MAGNE MAGBANUA
19 BUTANAS, NOE COLITA 19 BUTANAS, NOE COLITA 19 BUTANAS, NOE COLITA
20 JULIAN, JUNMAR DE LA CRUZ 20 JULIAN, JUNMAR DE LA CRUZ 20 JULIAN, JUNMAR DE LA CRUZ
21 AYAP, MARK ANGELO FULGENCIO 21 AYAP, MARK ANGELO FULGENCIO 21 AYAP, MARK ANGELO FULGENCIO
22 CATALUA, JAMES ROBERT MASONG 22 CATALUA, JAMES ROBERT MASONG 22 CATALUA, JAMES ROBERT MASONG
IMO CREW-LIST
(Passport, National Seaman Book & Joining Datas)
1. Name of the ship

P Arrival
2. Port of Arrival / Departure
Departure


12. Passport nos. & 13. Seamanbook nos. 14. Place & Date of
7.No 8. Family Name, Given Name 9. Rank 10. Nationality 11. Place & Date of Birth
Expiry Dates & Expiry Dates Joining
1 TRUHN, UKASZ PATRYK Master POLISH GDYNIA AT4669451 0212403 New York
22/Feb/1983 19/Jan/2018 UNLIMITED 18/Jan/2016
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO MANDAUE CITY EB5029024 C0157405 Singapore
02/May/1978 27/Mar/2017 11/Nov/2018 12/Mar/2016
3 TABANDA, RONALD BANO 2nd Off. FILIPINO ILOILO CITY EC3387899 C0348002 Singapore
04/Jun/1978 05/Feb/2020 03/Feb/2020 12/Mar/2016
4 ERANI, DAVOR 3rd Off. MONTENEGRIN BERANE F84BZ5897 1923/2011 Singapore
19/Mar/1990 09/May/2021 09/May/2021 29/Feb/2016
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN TALLIN KB0745160 MC0000470 New York
24/Nov/1961 20/Dec/2018 30/Jun/2019 18/Jan/2016
6 CACHO, RUFINO CASTRENCE 2nd Eng. FILIPINO ANDA PANGASINAN EC6403068 C0770861 Singapore
11/Mar/1974 13/Jan/2021 31/Jan/2021 29/Feb/2016
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO ILOCOS SUR EB7258820 B1260294 Singapore
28/Nov/1970 30/Jan/2018 13/Nov/2017 12/Mar/2016
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO MEDELLIN CEBU EC6116517 C0185463 Singapore
07/Feb/1964 30/Nov/2020 14/Jan/2019 13/Dec/2015
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO DAPITAN CITY EB7231344 C0375393 Singapore
01/Feb/1978 23/Jan/2018 25/Jan/2020 12/Mar/2016
10 ANG, JOVITO BALIAD A/B FILIPINO HINUNANGAN S LTE EC4153790 C0446522 Singapore
26/Jun/1969 11/May/2020 25/May/2020 13/Dec/2015
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO MANILA EC2864529 C0170332 Singapore
18/Jan/1973 27/Nov/2019 01/Dec/2018 12/Mar/2016
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S FILIPINO MANILA EC5478600 C0131007 Singapore
18/Sep/1985 24/Sep/2020 03/Sep/2018 12/Mar/2016
13 GENOSA, RYAN SEBONGA O/S FILIPINO HINIGARAN NEG OC EC4212610 C0057746 Hong Kong
29/May/1987 19/May/2020 02/Apr/2018 29/Jun/2015
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO BACOLOD CITY EC2498528 C0333242 Singapore
01/May/1984 21/Oct/2019 16/Oct/2019 12/Mar/2016
15 MARIN, GHEORGHE FTR ROMANA CONSTANTA 14531419 17398CT Singapore
27/Feb/1957 04/Nov/2018 01/Oct/2016 10/Oct/2015
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO ALTAVAS AKLAN EC2456794 C0171353 Singapore
23/May/1967 17/Oct/2019 02/Dec/2018 12/Mar/2016
17 TALINIO, PETER BENABAYE Oiler FILIPINO DAVAO CITY EB7587403 C0428913 Singapore
02/Jun/1976 07/Mar/2018 05/Jul/2020 12/Mar/2016
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper FILIPINO SAN JOSE ANTIQUE EC2615561 C0308976 Singapore
18/Jan/1985 03/Nov/2019 06/Nov/2019 12/Mar/2016
19 BUTANAS, NOE COLITA Wiper FILIPINO DANGCAGAN BKN EB9523619 C0168520 Hong Kong
21/Nov/1985 05/Nov/2018 15/Dec/2018 29/Jun/2015
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO MAKATO AKLAN EB8851797 C0310052 Singapore
27/Apr/1985 02/Aug/2018 18/Aug/2019 13/Dec/2015
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO TARLAC TARLAC EB8103829 C0056547 Hong Kong
28/Aug/1984 13/May/2018 31/Mar/2018 29/Jun/2015
22 CATALUA, JAMES ROBERT MASONG Deck Cade FILIPINO CAG DE ORO CITY EC1126184 C0217583 Singapore
29/May/1995 15/May/2019 04/Jun/2019 13/Dec/2015

Master m/v LENA-S.
IMO CREW-LIST
(Crew Body Temperature)
P Arrival Departure


7.No 8. Family Name, Given Name 9. Rank 10. Sex 11. Nationality 12. Date Of Birth 13. Body Temperature 14. Any Symtoms
1 TRUHN, UKASZ PATRYK Master M POLISH 22-Feb-83
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. M FILIPINO 2-May-78
3 TABANDA, RONALD BANO 2nd Off. M FILIPINO 4-Jun-78
4 ERANI, DAVOR 3rd Off. M MONTENEGRI 19-Mar-90
5 FILIMONOV, PAVEL Ch. Engr. M ESTONIAN 24-Nov-61
6 CACHO, RUFINO CASTRENCE 2nd Eng. M FILIPINO 11-Mar-74
7 IBERA, MELCHOR GUZMAN 3rd Eng. M FILIPINO 28-Nov-70
8 GRANADA, DIOSDADO MANGUBAT Electr. M FILIPINO 7-Feb-64
9 HIDLAO, MICHAEL TUMAPON Bosun M FILIPINO 1-Feb-78
10 ANG, JOVITO BALIAD A/B M FILIPINO 26-Jun-69
11 MERCADO, FREDERICK CORPUZ A/B M FILIPINO 18-Jan-73
12 DEOCAMPO, RODOLFO JR. HERMOSA O/S M FILIPINO 18-Sep-85
13 GENOSA, RYAN SEBONGA O/S M FILIPINO 29-May-87
14 GARROVILLO, IAN ROY CORDOVA O/S M FILIPINO 1-May-84
15 MARIN, GHEORGHE FTR M ROMANA 27-Feb-57
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler M FILIPINO 23-May-67
17 TALINIO, PETER BENABAYE Oiler M FILIPINO 2-Jun-76
18 CASALAN, CHARLE MAGNE MAGBANUA Wiper M FILIPINO 18-Jan-85
19 BUTANAS, NOE COLITA Wiper M FILIPINO 21-Nov-85
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook M FILIPINO 27-Apr-85
21 AYAP, MARK ANGELO FULGENCIO Messman M FILIPINO 28-Aug-84
22 CATALUA, JAMES ROBERT MASONG Deck Cadet M FILIPINO 29-May-95

Master m/v LENA-S.
IMO CREW-LIST
DATE & PLACE OF JOINING
Arrival X Departure

7.No 8. Family Name, Given Name 9. Nationality 10. Sex 11. Rank 11. Date of Birth 11a. Place of Birth 12. Date Of Embark 12a. Place Embark
1 TRUHN, UKASZ PATRYK POLISH M Master 22-Feb-1983 GDYNIA 18-Jan-2016 New York
2 HEYROSA, DARIUS MARTINQUILLA FILIPINO M Ch. Off. 2-May-1978 MANDAUE CITY 12-Mar-2016 Singapore
3 TABANDA, RONALD BANO FILIPINO M 2nd Off. 4-Jun-1978 ILOILO CITY 12-Mar-2016 Singapore
4 ERANI, DAVOR MONTENEGR M 3rd Off. 19-Mar-1990 BERANE 29-Feb-2016 Singapore
5 FILIMONOV, PAVEL ESTONIAN M Ch. Engr. 24-Nov-1961 TALLIN 18-Jan-2016 New York
ANDA
6 CACHO, RUFINO CASTRENCE FILIPINO M 2nd Eng. 11-Mar-1974 29-Feb-2016 Singapore
PANGASINAN
7 IBERA, MELCHOR GUZMAN FILIPINO M 3rd Eng. 28-Nov-1970 ILOCOS SUR 12-Mar-2016 Singapore
8 GRANADA, DIOSDADO MANGUBAT FILIPINO M Electr. 7-Feb-1964 MEDELLIN CEBU 13-Dec-2015 Singapore
9 HIDLAO, MICHAEL TUMAPON FILIPINO M Bosun 1-Feb-1978 DAPITAN CITY 12-Mar-2016 Singapore
HINUNANGAN S
10 ANG, JOVITO BALIAD FILIPINO M A/B 26-Jun-1969 13-Dec-2015 Singapore
LTE
11 MERCADO, FREDERICK CORPUZ FILIPINO M A/B 18-Jan-1973 MANILA 12-Mar-2016 Singapore
12 DEOCAMPO, RODOLFO JR. HERMOS FILIPINO M O/S 18-Sep-1985 MANILA 12-Mar-2016 Singapore
HINIGARAN NEG
13 GENOSA, RYAN SEBONGA FILIPINO M O/S 29-May-1987 29-Jun-2015 Hong Kong
OC
14 GARROVILLO, IAN ROY CORDOVA FILIPINO M O/S 1-May-1984 BACOLOD CITY 12-Mar-2016 Singapore
15 MARIN, GHEORGHE ROMANA M FTR 27-Feb-1957 CONSTANTA 10-Oct-2015 Singapore
16 LIBO-ON, ALBERTO JR. ONAYAN FILIPINO M Oiler 23-May-1967 ALTAVAS AKLAN 12-Mar-2016 Singapore
17 TALINIO, PETER BENABAYE FILIPINO M Oiler 2-Jun-1976 DAVAO CITY 12-Mar-2016 Singapore
SAN JOSE
18 CASALAN, CHARLE MAGNE MAGBAN FILIPINO M Wiper 18-Jan-1985 12-Mar-2016 Singapore
ANTIQUE
DANGCAGAN
19 BUTANAS, NOE COLITA FILIPINO M Wiper 21-Nov-1985 29-Jun-2015 Hong Kong
BKN
20 JULIAN, JUNMAR DE LA CRUZ FILIPINO M Ch. Cook 27-Apr-1985 MAKATO AKLAN 13-Dec-2015 Singapore
21 AYAP, MARK ANGELO FULGENCIO FILIPINO M Messman 28-Aug-1984 TARLAC TARLAC 29-Jun-2015 Hong Kong
CAG DE ORO
22 CATALUA, JAMES ROBERT MASONG FILIPINO M Deck Cadet 29-May-1995 13-Dec-2015 Singapore
CITY

Master m/v LENA-S.
IMO CREW-LIST
(National Seaman Book & Passport)
X Arrival Departure


7.No 8. Family Name, Given Name 9. Nationality 10. Sex 11. Rank 11. Date of Birth 11a. Place of Birth 12.Seaman Bk No. 12a. Expiry date 13. Passport No.. 13a. Expiry date
1 TRUHN, UKASZ PATRYK POLISH M Master 22-Feb-1983 GDYNIA 0212403 UNLIMITED AT4669451 19-Jan-2018
2 HEYROSA, DARIUS MARTINQUILLA FILIPINO M Ch. Off. 2-May-1978 MANDAUE CITY C0157405 11-Nov-2018 EB5029024 27-Mar-2017
3 TABANDA, RONALD BANO FILIPINO M 2nd Off. 4-Jun-1978 ILOILO CITY C0348002 03-Feb-2020 EC3387899 05-Feb-2020
4 ERANI, DAVOR MONTENEGRIN M 3rd Off. 19-Mar-1990 BERANE 1923/2011 09-May-2021 F84BZ5897 09-May-2021
5 FILIMONOV, PAVEL ESTONIAN M Ch. Engr. 24-Nov-1961 TALLIN MC0000470 30-Jun-2019 KB0745160 20-Dec-2018
ANDA
6 CACHO, RUFINO CASTRENCE FILIPINO M 2nd Eng. 11-Mar-1974 C0770861 31-Jan-2021 EC6403068 13-Jan-2021
PANGASINAN
7 IBERA, MELCHOR GUZMAN FILIPINO M 3rd Eng. 28-Nov-1970 ILOCOS SUR B1260294 13-Nov-2017 EB7258820 30-Jan-2018
8 GRANADA, DIOSDADO MANGUBAT FILIPINO M Electr. 7-Feb-1964 MEDELLIN CEBU C0185463 14-Jan-2019 EC6116517 30-Nov-2020
9 HIDLAO, MICHAEL TUMAPON FILIPINO M Bosun 1-Feb-1978 DAPITAN CITY C0375393 25-Jan-2020 EB7231344 23-Jan-2018
HINUNANGAN S
10 ANG, JOVITO BALIAD FILIPINO M A/B 26-Jun-1969 C0446522 25-May-2020 EC4153790 11-May-2020
LTE
11 MERCADO, FREDERICK CORPUZ FILIPINO M A/B 18-Jan-1973 MANILA C0170332 01-Dec-2018 EC2864529 27-Nov-2019
12 DEOCAMPO, RODOLFO JR. HERMOSA FILIPINO M O/S 18-Sep-1985 MANILA C0131007 03-Sep-2018 EC5478600 24-Sep-2020
HINIGARAN NEG
13 GENOSA, RYAN SEBONGA FILIPINO M O/S 29-May-1987 C0057746 02-Apr-2018 EC4212610 19-May-2020
OC
14 GARROVILLO, IAN ROY CORDOVA FILIPINO M O/S 1-May-1984 BACOLOD CITY C0333242 16-Oct-2019 EC2498528 21-Oct-2019
15 MARIN, GHEORGHE ROMANA M FTR 27-Feb-1957 CONSTANTA 17398CT 01-Oct-2016 14531419 04-Nov-2018
16 LIBO-ON, ALBERTO JR. ONAYAN FILIPINO M Oiler 23-May-1967 ALTAVAS AKLAN C0171353 02-Dec-2018 EC2456794 17-Oct-2019
17 TALINIO, PETER BENABAYE FILIPINO M Oiler 2-Jun-1976 DAVAO CITY C0428913 05-Jul-2020 EB7587403 07-Mar-2018
SAN JOSE
18 CASALAN, CHARLE MAGNE MAGBANUA FILIPINO M Wiper 18-Jan-1985 C0308976 06-Nov-2019 EC2615561 03-Nov-2019
ANTIQUE
DANGCAGAN
19 BUTANAS, NOE COLITA FILIPINO M Wiper 21-Nov-1985 C0168520 15-Dec-2018 EB9523619 05-Nov-2018
BKN
20 JULIAN, JUNMAR DE LA CRUZ FILIPINO M Ch. Cook 27-Apr-1985 MAKATO AKLAN C0310052 18-Aug-2019 EB8851797 02-Aug-2018
21 AYAP, MARK ANGELO FULGENCIO FILIPINO M Messman 28-Aug-1984 TARLAC TARLAC C0056547 31-Mar-2018 EB8103829 13-May-2018
CAG DE ORO
22 CATALUA, JAMES ROBERT MASONG FILIPINO M Deck Cadet 29-May-1995 C0217583 04-Jun-2019 EC1126184 15-May-2019
CITY

Master m/v LENA-S.
IMO CREW-LIST
(Antigua & Barbuda Seaman Book & Passport)
1. Name of the ship

P Arrival
Departure


7.No 8. Family Name, Given Name 9. Nationality 10. Sex 11. Rank 11. Date of Birth 11a. Place of Birth 12.A & B No. 12a. Expiry date 13. Passport No.. 13a. Expiry date
1 TRUHN, UKASZ PATRYK POLISH M Master 22-Feb-1983 GDYNIA 116834 22-Dec-2016 AT4669451 19-Jan-2018
2 HEYROSA, DARIUS MARTINQUILLA FILIPINO M Ch. Off. 2-May-1978 MANDAUE CITY 0 30-Dec-1899 EB5029024 27-Mar-2017
3 TABANDA, RONALD BANO FILIPINO M 2nd Off. 4-Jun-1978 ILOILO CITY 0 30-Dec-1899 EC3387899 05-Feb-2020
4 ERANI, DAVOR MONTENEGRIN M 3rd Off. 19-Mar-1990 BERANE 0 30-Dec-1899 F84BZ5897 09-May-2021
5 FILIMONOV, PAVEL ESTONIAN M Ch. Engr. 24-Nov-1961 TALLIN 51704 05-Jul-2020 KB0745160 20-Dec-2018
ANDA
6 CACHO, RUFINO CASTRENCE FILIPINO M 2nd Eng. 11-Mar-1974 65686 07-Feb-2017 EC6403068 13-Jan-2021
PANGASINAN
7 IBERA, MELCHOR GUZMAN FILIPINO M 3rd Eng. 28-Nov-1970 ILOCOS SUR 0 30-Dec-1899 EB7258820 30-Jan-2018
8 GRANADA, DIOSDADO MANGUBAT FILIPINO M Electr. 7-Feb-1964 MEDELLIN CEBU 0 30-Dec-1899 EC6116517 30-Nov-2020
9 HIDLAO, MICHAEL TUMAPON FILIPINO M Bosun 1-Feb-1978 DAPITAN CITY 0 30-Dec-1899 EB7231344 23-Jan-2018
HINUNANGAN S
10 ANG, JOVITO BALIAD FILIPINO M A/B 26-Jun-1969 0 30-Dec-1899 EC4153790 11-May-2020
LTE
11 MERCADO, FREDERICK CORPUZ FILIPINO M A/B 18-Jan-1973 MANILA 0 30-Dec-1899 EC2864529 27-Nov-2019
12 DEOCAMPO, RODOLFO JR. HERMO FILIPINO M O/S 18-Sep-1985 MANILA 0 30-Dec-1899 EC5478600 24-Sep-2020
HINIGARAN NEG
13 GENOSA, RYAN SEBONGA FILIPINO M O/S 29-May-1987 115774 15-Nov-2016 EC4212610 19-May-2020
OC
14 GARROVILLO, IAN ROY CORDOVA FILIPINO M O/S 1-May-1984 BACOLOD CITY 0 30-Dec-1899 EC2498528 21-Oct-2019
15 MARIN, GHEORGHE ROMANA M FTR 27-Feb-1957 CONSTANTA 69992 22-Feb-2017 14531419 04-Nov-2018
16 LIBO-ON, ALBERTO JR. ONAYAN FILIPINO M Oiler 23-May-1967 ALTAVAS AKLAN 0 30-Dec-1899 EC2456794 17-Oct-2019
17 TALINIO, PETER BENABAYE FILIPINO M Oiler 2-Jun-1976 DAVAO CITY 0 30-Dec-1899 EB7587403 07-Mar-2018
SAN JOSE
18 CASALAN, CHARLE MAGNE MAGBA FILIPINO M Wiper 18-Jan-1985 0 30-Dec-1899 EC2615561 03-Nov-2019
ANTIQUE
DANGCAGAN
19 BUTANAS, NOE COLITA FILIPINO M Wiper 21-Nov-1985 141706 13-Jan-2020 EB9523619 05-Nov-2018
BKN
20 JULIAN, JUNMAR DE LA CRUZ FILIPINO M Ch. Cook 27-Apr-1985 MAKATO AKLAN 0 30-Dec-1899 EB8851797 02-Aug-2018
21 AYAP, MARK ANGELO FULGENCIO FILIPINO M Messman 28-Aug-1984 TARLAC TARLAC 137131 27-May-2019 EB8103829 13-May-2018
CAG DE ORO
22 CATALUA, JAMES ROBERT MASO FILIPINO M Deck Cadet 29-May-1995 0 30-Dec-1899 EC1126184 15-May-2019
CITY

Master m/v LENA-S.
IMO CREW-LIST
(Passport - National Seaman Book - Antigua & Barbuda - Joining Datas)
1. Name of the ship

P Arrival
Departure


7.No 8. Family Name, Given Name 9. Rank 10. Nationality 11. Place & Date of Birth 12. Passport nos. & 13. Seamanbook nos. 14. A & B nos. & 15. Place & Date of
Expiry Dates & Expiry Dates Expiry Dates Joining
1 TRUHN, UKASZ PATRYK Master POLISH
POLISH AT4669451 0212403 116834 New York
22/Feb/1983 19/Jan/2018 UNLIMITED 22/Dec/2016 18/Jan/2016
2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. FILIPINO MANDAUE CITY EB5029024 C0157405 0 Singapore
02/May/1978 27/Mar/2017 11/Nov/2018 30/Dec/1899 12/Mar/2016
3 TABANDA, RONALD BANO 2nd Off. FILIPINO ILOILO CITY EC3387899 C0348002 0 Singapore
04/Jun/1978 05/Feb/2020 03/Feb/2020 30/Dec/1899 12/Mar/2016
4 ERANI, DAVOR 3rd Off.MONTENEGRIN BERANE F84BZ5897 1923/2011 0 Singapore
19/Mar/1990 09/May/2021 09/May/2021 30/Dec/1899 29/Feb/2016
5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN TALLIN KB0745160 MC0000470 51704 New York
24/Nov/1961 20/Dec/2018 30/Jun/2019 05/Jul/2020 18/Jan/2016
6 CACHO, RUFINO CASTRENCE 2nd Eng. FILIPINO ANDA PANGASINAN EC6403068 C0770861 65686 Singapore
11/Mar/1974 13/Jan/2021 31/Jan/2021 07/Feb/2017 29/Feb/2016
7 IBERA, MELCHOR GUZMAN 3rd Eng. FILIPINO ILOCOS SUR EB7258820 B1260294 0 Singapore
28/Nov/1970 30/Jan/2018 13/Nov/2017 30/Dec/1899 12/Mar/2016
8 GRANADA, DIOSDADO MANGUBAT Electr. FILIPINO MEDELLIN CEBU EC6116517 C0185463 0 Singapore
07/Feb/1964 30/Nov/2020 14/Jan/2019 30/Dec/1899 13/Dec/2015
9 HIDLAO, MICHAEL TUMAPON Bosun FILIPINO DAPITAN CITY EB7231344 C0375393 0 Singapore
01/Feb/1978 23/Jan/2018 25/Jan/2020 30/Dec/1899 12/Mar/2016
10 ANG, JOVITO BALIAD A/B FILIPINO HINUNANGAN S LTE EC4153790 C0446522 0 Singapore
26/Jun/1969 11/May/2020 25/May/2020 30/Dec/1899 13/Dec/2015
11 MERCADO, FREDERICK CORPUZ A/B FILIPINO MANILA EC2864529 C0170332 0 Singapore
18/Jan/1973 27/Nov/2019 01/Dec/2018 30/Dec/1899 12/Mar/2016
12 DEOCAMPO, RODOLFO JR. HERMOS O/S FILIPINO MANILA EC5478600 C0131007 0 Singapore
18/Sep/1985 24/Sep/2020 03/Sep/2018 30/Dec/1899 12/Mar/2016
13 GENOSA, RYAN SEBONGA O/S FILIPINO HINIGARAN NEG OC EC4212610 C0057746 115774 Hong Kong
29/May/1987 19/May/2020 02/Apr/2018 15/Nov/2016 29/Jun/2015
14 GARROVILLO, IAN ROY CORDOVA O/S FILIPINO BACOLOD CITY EC2498528 C0333242 0 Singapore
01/May/1984 21/Oct/2019 16/Oct/2019 30/Dec/1899 12/Mar/2016
15 MARIN, GHEORGHE FTR ROMANA CONSTANTA 14531419 17398CT 69992 Singapore
27/Feb/1957 04/Nov/2018 01/Oct/2016 22/Feb/2017 10/Oct/2015
16 LIBO-ON, ALBERTO JR. ONAYAN Oiler FILIPINO ALTAVAS AKLAN EC2456794 C0171353 0 Singapore
23/May/1967 17/Oct/2019 02/Dec/2018 30/Dec/1899 12/Mar/2016
17 TALINIO, PETER BENABAYE Oiler FILIPINO DAVAO CITY EB7587403 C0428913 0 Singapore
02/Jun/1976 07/Mar/2018 05/Jul/2020 30/Dec/1899 12/Mar/2016
18 CASALAN, CHARLE MAGNE MAGBAN Wiper FILIPINO SAN JOSE ANTIQUE EC2615561 C0308976 0 Singapore
18/Jan/1985 03/Nov/2019 06/Nov/2019 30/Dec/1899 12/Mar/2016
19 BUTANAS, NOE COLITA Wiper FILIPINO DANGCAGAN BKN EB9523619 C0168520 141706 Hong Kong
21/Nov/1985 05/Nov/2018 15/Dec/2018 13/Jan/2020 29/Jun/2015
20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook FILIPINO MAKATO AKLAN EB8851797 C0310052 0 Singapore
27/Apr/1985 02/Aug/2018 18/Aug/2019 30/Dec/1899 13/Dec/2015
21 AYAP, MARK ANGELO FULGENCIO Messman FILIPINO TARLAC TARLAC EB8103829 C0056547 137131 Hong Kong
28/Aug/1984 13/May/2018 31/Mar/2018 27/May/2019 29/Jun/2015
22 CATALUA, JAMES ROBERT MASONGDeck Cadet FILIPINO CAG DE ORO CITY EC1126184 C0217583 0 Singapore
29/May/1995 15/May/2019 04/Jun/2019 30/Dec/1899 13/Dec/2015
16. Date and signature by master, authorized agent or officer Capt. TRUHN, UKASZ PATRYK
Master m/v LENA-S.
IMO CARGO DECLARATION Page -1
x Arrival Departure
1.Name of Ship; 2.Port of Arrival;
m/v "LENA-S."
COLOMBO, SRI LANKA
3.Nationality of Ship; 4.Name of Master; 5.Port of Departure
Antigua & Barbuda Capt. TRUHN, UKASZ PATRYK

SINGAPORE
DECK AND BOTTOM DECLARATION
TOTAL ON DECK UNDER DECK

TOTAL ON BOARD AT
THE TIME OF IMO CARGO - NIL IMO CARGO - NIL IMO CARGO - NIL
ARRIVAL
TEU'S
WEIGHT
UNITS
DATE; 19/Jun/2015 MASTER; Capt. TRUHN, UKASZ PATRYK

" COLOMBO " FORM ONLY

Port Clearance (Originial)

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Port Clearance (Originial)

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IMO GENERAL DECALARATION

m/v "LENA-S." COLOMBO, SRI LANKA 16/Mar/2016 8:30

4. Nationality of ship 5. Name of master 6. Port arrived from / port of destination

ST. JOHN'S - 12 May 2010 - SSR-No 1882

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

13. Brief description of the cargo

22.Crew's effect declaration* 23. Maritime declartion of health*

1 1 Wednesday, March 16, 2016 Capt. TRUHN, UKASZ PATRYK

For official use

C94 * Only on arrival

6 NIL List / ammunition List callao 2 2 2 3 1

Ship's Particulars " A" Ship's Particulars " A"

4 ERANI, DAVOR 3rd Off. MONTENEGRIN 19-Mar-1990 BERANE F84BZ5897 09-May-2021

5 FILIMONOV, PAVEL Ch. Engr. ESTONIAN 24-Nov-1961 TALLIN KB0745160 20-Dec-2018

11 MERCADO, FREDERICK CORPUZ A/B FILIPINO 18-Jan-1973 MANILA EC2864529 27-Nov-2019

15 MARIN, GHEORGHE FTR ROMANA 27-Feb-1957 CONSTANTA 14531419 04-Nov-2018

C0157405 11-Nov-2018 Manila 12-Mar-2016 Singapore R C1/D

C0348002 03-Feb-2020 Manila 12-Mar-2016 Singapore R C1/D

1923/2011 09-May-2021 Kotor Oct-2021 29-Feb-2016 Singapore R C1/D K4935574

C0770861 31-Jan-2021 65686 07-Feb-2017 Jun-2019 29-Feb-2016 Singapore R C1/D H2015054

B1260294 13-Nov-2017 Manila 12-Mar-2016 Singapore R C1/D

C0185463 14-Jan-2019 Manila Feb-2024 13-Dec-2015 Singapore R C1/D

C0375393 25-Jan-2020 Manila 12-Mar-2016 Singapore R C1/D

C0446522 25-May-2020 Manila May-2019 13-Dec-2015 Singapore R C1/D K6037005

C0170332 01-Dec-2018 Manila 12-Mar-2016 Singapore R C1/D

C0131007 03-Sep-2018 Manila 12-Mar-2016 Singapore R C1/D

C0333242 16-Oct-2019 Manila 12-Mar-2016 Singapore R C1/D

C0171353 02-Dec-2018 Manila 12-Mar-2016 Singapore R C1/D

C0428913 05-Jul-2020 Manila 12-Mar-2016 Singapore R C1/D

C0308976 06-Nov-2019 Manila 12-Mar-2016 Singapore R C1/D

C0310052 18-Aug-2019 Manila Apr-2018 13-Dec-2015 Singapore R C1/D H8526069

C0217583 04-Jun-2019 Manila Oct-2024 13-Dec-2015 Singapore R C1/D K2979164

m/v "LENA-S." COLOMBO, SRI LANKA 16-Mar-2016

Antigua & Barbuda SINGAPORE NEW YORK, U.S.A

1 TRUHN, UKASZ PATRYK Master M POLISH GDYNIA 22-Feb-1983 AT4669451 19-Jan-2018

4 ERANI, DAVOR 3rd Off. M MONTENEGRIN BERANE 19-Mar-1990 F84BZ5897 09-May-2021

5 FILIMONOV, PAVEL Ch. Engr. M ESTONIAN TALLIN 24-Nov-1961 KB0745160 20-Dec-2018

11 MERCADO, FREDERICK CORPUZ A/B M FILIPINO MANILA 18-Jan-1973 EC2864529 27-Nov-2019

15 MARIN, GHEORGHE FTR M ROMANA CONSTANTA 27-Feb-1957 14531419 04-Nov-2018

13. Date and signature by master, authorized agent or officer

Capt. TRUHN, UKASZ PATRYK

m/v " LENA-S. " COLOMBO, SRI LANKA

Antigua & Barbuda SINGAPORE

1 TRUHN, UKASZ PATRYK Master M POLISH GDYNIA

2 HEYROSA, DARIUS MARTINQUILLA Ch. Off. M FILIPINO MANDAUE CITY

3 TABANDA, RONALD BANO 2nd Off. M FILIPINO ILOILO CITY

4 ERANI, DAVOR 3rd Off. M MONTENEGRIN BERANE

5 FILIMONOV, PAVEL Ch. Engr. M ESTONIAN TALLIN

7 IBERA, MELCHOR GUZMAN 3rd Eng. M FILIPINO ILOCOS SUR

8 GRANADA, DIOSDADO MANGUBAT Electr. M FILIPINO MEDELLIN CEBU

9 HIDLAO, MICHAEL TUMAPON Bosun M FILIPINO DAPITAN CITY

11 MERCADO, FREDERICK CORPUZ A/B M FILIPINO MANILA

12 DEOCAMPO, RODOLFO JR. HERMOSA O/S M FILIPINO MANILA

14 GARROVILLO, IAN ROY CORDOVA O/S M FILIPINO BACOLOD CITY

15 MARIN, GHEORGHE FTR M ROMANA CONSTANTA

16 LIBO-ON, ALBERTO JR. ONAYAN Oiler M FILIPINO ALTAVAS AKLAN

17 TALINIO, PETER BENABAYE Oiler M FILIPINO DAVAO CITY

20 JULIAN, JUNMAR DE LA CRUZ Ch. Cook M FILIPINO MAKATO AKLAN

21 AYAP, MARK ANGELO FULGENCIO Messman M FILIPINO TARLAC TARLAC

13. Date and signature by master, authorized agent or officer

3. Date of Arrival / Departure

NEW YORK, U.S.A 6 hrs. before

22-Feb-1983 AT4669451 19-Jan-2018 35,8/ 35.7