This form contains 147 fields organized into 35 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Alongside Location
Port Text
Please enter the name of the port where the vessel is alongside. Fill only if 'Alongside' is 'Yes'.
Depends on: Alongside
Country Text
Please enter the name of the country where the vessel is alongside. Fill only if 'Alongside' is 'Yes'.
Depends on: Alongside
Approved Security Plan
Yes Radiobutton
Check this box if the vessel has an approved security plan.
No Radiobutton
Check this box if the vessel does not have an approved security plan.
Arrival Information
Arrival Date Date
Enter the date of arrival.
Arrival Time (UTC) Time
Enter the time of arrival in UTC.
At Sea Information
Vessel Course Number
Please enter the vessel's course in degrees true. Fill only if 'At sea' is 'Yes'.
Depends on: At sea
Vessel Speed Number
Please enter the vessel's speed in knots. Fill only if 'At sea' is 'Yes'.
Depends on: At sea
Cargo Information
General Cargo Description and Amount Text
Please provide a general description of the cargo and its amount.
Dangerous Goods Description Text
If applicable, please provide a description of any dangerous goods or devices on board.
Completion Dates for Last 10 Declarations of Security
Date of Declaration of Security 1 Date
Enter the date of the most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 2 Date
Enter the date of the second most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 3 Date
Enter the date of the third most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 4 Date
Enter the date of the fourth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 5 Date
Enter the date of the fifth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 6 Date
Enter the date of the sixth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 7 Date
Enter the date of the seventh most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 8 Date
Enter the date of the eighth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 9 Date
Enter the date of the ninth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Date of Declaration of Security 10 Date
Enter the date of the tenth most recent Declaration of Security. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Current Vessel Latitude
Current Latitude Degrees Number
Enter the degrees component of the vessel's current latitude.
Max length: 3 characters
Current Latitude Minutes Number
Enter the minutes component of the vessel's current latitude.
Max length: 2 characters
Current Latitude Seconds Number
Enter the seconds component of the vessel's current latitude.
Max length: 2 characters
Current Latitude Direction Combobox
Enter the cardinal direction (e.g., N for North, S for South) for the vessel's current latitude.
S N
Current Vessel Longitude
Longitude Degrees Text
Enter the degrees component of the vessel's current longitude.
Max length: 3 characters
Longitude Minutes Text
Enter the minutes component of the vessel's current longitude.
Max length: 2 characters
Longitude Seconds Text
Enter the seconds component of the vessel's current longitude.
Max length: 2 characters
Longitude Direction Combobox
Enter the directional component (e.g., E for East or W for West) of the vessel's current longitude.
W E
Current Vessel MARSEC Level
Level 1 Radiobutton
Check this box if the current vessel MARSEC level is Level 1. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Level 2 Radiobutton
Check this box if the current vessel MARSEC level is Level 2. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Level 3 Radiobutton
Check this box if the current vessel MARSEC level is Level 3. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Departure Date and Time
Departure Date Date
Please enter the date of departure.
Departure Time (UTC) Time
Please enter the time of departure in UTC.
Departure Information
Departure Date Date
Enter the date of departure.
Departure Time (UTC) Time
Enter the time of departure in UTC.
Eighth Marine Facility/Port Details
Terminal Text
Provide the name of the marine terminal.
Berth Text
Provide the specific berth at the marine facility.
Port Text
Provide the name of the port.
Country Text
Provide the name of the country where the port is located.
Arrival Date Date
Provide the date of arrival.
Arrival Time (UTC) Time
Provide the time of arrival in UTC.
Departure Date Date
Provide the date of departure.
Departure Time (UTC) Time
Provide the time of departure in UTC.
Fifth Marine Facility/Port Details
Terminal Text
Provide the name of the terminal for the fifth marine facility or port.
Berth Text
Provide the berth number or name for the fifth marine facility or port.
Port Text
Provide the name of the port for the fifth marine facility.
Country Text
Provide the country where the fifth marine facility or port is located.
Arrival Date Date
Provide the arrival date for the fifth marine facility.
Arrival Time (UTC) Time
Provide the arrival time in UTC for the fifth marine facility.
Departure Date Date
Provide the departure date from the fifth marine facility.
Departure Time (UTC) Time
Provide the departure time in UTC from the fifth marine facility.
Final Canadian POC Contact Person Details
Contact Person Name Text
Please provide the name of the contact person at the marine facility for the final Canadian Port of Call.
Telephone Number Text
Please provide the 24-hour telephone number for the contact person at the marine facility for the final Canadian Port of Call. Fill only if 'Contact Person Name' is filled.
Depends on: Contact Person Name
Fax Number Text
Please provide the fax number for the contact person at the marine facility for the final Canadian Port of Call. Fill only if 'Contact Person Name' is filled.
Depends on: Contact Person Name
Final Canadian POC Details
Final Canadian Port of Call Text
Please enter the name of the final Canadian Port of Call, if applicable.
Estimated Date of Arrival Date
Please enter the estimated date of arrival at the final Canadian Port of Call.
Estimated Time of Arrival (UTC) Time
Please enter the estimated time of arrival at the final Canadian Port of Call in UTC.
First Canadian POC Contact Person Details
Contact Person Name Text
Provide the full name of the contact person at the marine facility for the first Canadian Port Of Call.
Contact Person Telephone Number Text
Provide the 24-hour telephone number for the contact person at the marine facility for the first Canadian Port Of Call. Fill only if 'Contact Person Name' is filled.
Depends on: Contact Person Name
Contact Person Fax Number Text
Provide the fax number for the contact person at the marine facility for the first Canadian Port Of Call. Fill only if 'Contact Person Name' is filled.
Depends on: Contact Person Name
First Canadian POC Details
Destination (First Canadian POC) Text
Provide the name of the first Canadian Point of Contact (POC) destination.
Estimated Arrival Date (First Canadian POC) Date
Enter the estimated date of arrival at the first Canadian Point of Contact.
Estimated Arrival Time (First Canadian POC) (UTC) Time
Enter the estimated time of arrival at the first Canadian Point of Contact in UTC.
First Marine Facility/Port Details
Terminal Text
Enter the name of the marine terminal for the first port of call.
Berth Text
Enter the specific berth number or name at the marine facility.
Port Name Text
Enter the name of the port for the first port of call.
Country Text
Enter the country where the marine facility/port is located.
Arrival Date Date
Provide the date of arrival at the first marine facility/port.
Arrival Time (UTC) Time
Provide the arrival time in UTC at the first marine facility/port.
Departure Date Date
Provide the date of departure from the first marine facility/port.
Departure Time (UTC) Time
Provide the departure time in UTC from the first marine facility/port.
Fourth Marine Facility/Port Details
Fourth Marine Facility Terminal Text
Provide the name of the terminal for the fourth marine facility.
Fourth Marine Facility Berth Text
Provide the berth number or name for the fourth marine facility.
Fourth Marine Facility Port Text
Provide the name of the port for the fourth marine facility.
Fourth Marine Facility Country Text
Provide the country where the fourth marine facility's port is located.
Fourth Marine Facility Arrival Date Date
Provide the date of arrival at the fourth marine facility.
Fourth Marine Facility Arrival Time (UTC) Time
Provide the time of arrival at the fourth marine facility in UTC.
Master's Name
Master's Name Text
Provide the full name of the vessel's master.
Ninth Marine Facility/Port Details
Terminal Text
Please enter the name of the marine terminal.
Berth Text
Please enter the berth number or name at the marine facility.
Port Text
Please enter the name of the port.
Country Text
Please enter the country where the marine facility/port is located.
Arrival Date Date
Please enter the date of arrival at the marine facility.
Arrival Time (UTC) Time
Please enter the time of arrival at the marine facility in UTC.
Departure Date Date
Please enter the date of departure from the marine facility.
Departure Time (UTC) Time
Please enter the time of departure from the marine facility in UTC.
Position / Arrival Details
Current Date Date
Please provide the current date.
Current Time (UTC) Time
Please provide the current time in UTC.
Primary Charterer Name
Primary Charterer Name Text
Please provide the name of the primary charterer, if applicable.
Second Marine Facility/Port Details
Terminal Text
Please enter the name of the terminal for the second marine facility/port.
Berth Text
Please enter the berth for the second marine facility/port.
Port Text
Please enter the name of the port for the second marine facility/port.
Country Text
Please enter the country where the second marine facility/port is located.
Arrival Date Date
Please enter the arrival date at the second marine facility/port.
Arrival Time (UTC) Time
Please enter the arrival time (UTC) at the second marine facility/port.
Departure Date Date
Please enter the departure date from the second marine facility/port.
Departure Time (UTC) Time
Please enter the departure time (UTC) from the second marine facility/port.
Security Breach Details
Security Breach Details Text
Provide details of any security breach, incident, or threat that occurred at the last 10 Ports Of Call or while in transit between them. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Security or Communications Deficiencies
Security or Communications Deficiencies and Rectification Text
Provide details of any deficiencies found in security or communications systems and explain how these will be rectified. Fill only if 'This vessel has an approved security plan' is 'Yes'.
Depends on: Yes
Seventh Marine Facility/Port Details
Terminal Text
Please enter the name of the marine terminal.
Berth Text
Please enter the specific berth number or name within the terminal.
Port Text
Please enter the name of the port.
Country Text
Please enter the country where the port is located.
Arrival Date Date
Please enter the date of arrival at the facility/port.
Arrival Time (UTC) Time
Please enter the time of arrival at the facility/port in UTC.
Departure Date Date
Please enter the date of departure from the facility/port.
Departure Time (UTC) Time
Please enter the time of departure from the facility/port in UTC.
Ship Compliance Document Details
Document Number Text
Enter the ISSC/CVSC or ship compliance document number. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Document Issued By Text
Enter the name of the entity that issued the document. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Document Issue Date Date
Enter the date the document was issued. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Document Expiry Date Date
Enter the date the document will expire. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Sixth Marine Facility/Port Details
Terminal Text
Enter the name of the marine facility terminal.
Berth Text
Enter the berth designation within the marine facility.
Port Text
Enter the name of the port where the marine facility is located.
Country Text
Enter the country where the marine facility is located.
Arrival date Date
Enter the date of arrival at the marine facility.
Arrival time (UTC) Time
Enter the time of arrival at the marine facility in UTC.
Departure date Date
Enter the date of departure from the marine facility.
Departure time (UTC) Time
Enter the time of departure from the marine facility in UTC.
Tenth Marine Facility/Port Details
Tenth Terminal Text
Enter the name of the tenth marine terminal.
Tenth Berth Text
Enter the berth number or name for the tenth marine facility.
Tenth Port Text
Enter the name of the tenth marine port.
Tenth Country Text
Enter the country where the tenth marine facility is located.
Third Marine Facility/Port Details
Third Marine Facility Terminal Text
Enter the name of the terminal for the third marine facility.
Third Marine Facility Berth Text
Enter the berth number or name for the third marine facility.
Third Marine Facility Port Text
Enter the name of the port for the third marine facility.
Third Marine Facility Country Text
Enter the country where the third marine facility port is located.
Third Marine Facility Arrival Date Date
Enter the arrival date at the third marine facility.
Third Marine Facility Arrival Time UTC Time
Enter the arrival time at the third marine facility in UTC.
Third Marine Facility Departure Date Date
Enter the departure date from the third marine facility.
Third Marine Facility Departure Time UTC Time
Enter the departure time from the third marine facility in UTC.
Vessel Agent Details
Vessel Agent Name Text
Enter the name of the vessel agent if applicable.
Vessel Agent Telephone Number Text
Enter the vessel agent's 24-hour telephone number. Fill only if 'Vessel Agent Name' is filled.
Depends on: Vessel Agent Name
Vessel Agent Email Address Text
Enter the optional email address of the vessel agent. Fill only if 'Vessel Agent Name' is filled.
Depends on: Vessel Agent Name
Vessel Agent Fax Number Text
Enter the fax number of the vessel agent. Fill only if 'Vessel Agent Name' is filled.
Depends on: Vessel Agent Name
Vessel Contact Information
Vessel E-mail Text
Provide the vessel's primary email address.
Vessel Satellite or Cellular Number Text
Provide the vessel's satellite or cellular telephone number.
Vessel Details
Vessel Name Text
Provide the official name of the vessel.
Country of Registry Text
Enter the country where the vessel is officially registered.
Registered Owner Name Text
Provide the full name of the registered owner of the vessel.
Operator Name Text
Provide the full name of the vessel's operating company or individual operator.
Classification Society Name Text
Enter the name of the classification society that certifies the vessel.
International Radio Call Sign Text
Provide the vessel's unique International Radio Call Sign.
IMO Number Number
Enter the vessel's International Maritime Organization (IMO) identification number.
Max length: 7 characters
IMO Company or Registered Owner Number Number
Provide the IMO company number or the IMO registered owner number.
Max length: 7 characters
Vessel Status
Alongside Radiobutton
Check this box if the vessel is currently alongside a port.
At sea Radiobutton
Check this box if the vessel is currently at sea.