1. SHIP INFORMATION
 Ship's name
 Type
 IMO number
 Owner
 Gross tonnage
 Call sign
 Flag
 Arrival date
 Agent
 Last port and country    
 Next port and country    
 Arrival port

2. BALLAST WATER
 Specific units m3 MT LT ST
 Total ballast water on board
 Total ballast water capacity

3. BALLAST WATER TANKS
 Ballast water management plan on board? yes           no
 Management plan implemented? yes          no
 Total number of ballast tanks on board
 No.of tanks in ballast
 No.of tanks exchanged
 No.of tanks not exchanged

Select the RowNumber Click here(To fill the table below just drop down for the row number )

4. BALLAST WATER HISTORY: RECORD ALL TANKS THAT WILL BE DEBALLASTED IN PORT STATE OF ARRIVAL
Tanks/holds
list multiple sources
per tank
seperately		 BALLAST WATER SOURCE BALLAST WATER EXCHANGE
 BALLAST WATER DISCHARGE
Date
DDMMYY		 Port or lat/long Volume(units) Tempe
rature(units)		 Date
DDMMYY		 End point lat/long Volume(units) % ex change Sea height(m) Date
DDMMYY		 Port or lat/long Volume(units) Salinity(units)
Ballast water tank codes forepeak=FP; aftpeak=AP; double bottom=DB; wing=WT; topside=TS; cargo hold=CH; other=0. Please number the tanks as FP1,FP2,FP3....

If exchanges were not conducted, state other control action(s) taken
If none state reasons why not

5. IMO BALLAST WATER GUIDELINES ON BOARD
Resolution A 868(20)? yes           no
Responsible officer's name and title
Comment


The data entered is saved to the file:                 


On clicking on this button, the data will be written to an xml file