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PART A: To be completed by the master of the vessel | |||||||||
Name of vessel | IMO Numbera | Radio Call Sign | Flag State | ||||||
Inmarsat Number | Telefax Number | Telephone Number | E-mail address | ||||||
Port of landing or transhipment | Estimated Time of Arrival | ||||||||
Date: | Time (UTC): | ||||||||
Total catch on board | Catch to be landedb | ||||||||
Speciesc | Productd | ICES area of catch | Product weight (kg) | Speciesc | Productd | ICES area of catch | Product weight (kg) |
PART B: For official use only — to be completed by the Flag State | |||||
The Flag State of the vessel must respond to the following questions by marking ‘Yes’ or ‘No’ | Yes | No | |||
a) The fishing vessel declared to have caught the fish had sufficient quota for the species declared | |||||
b) The quantities on board have been duly reported and taken into account for the calculation of any catch or effort limitations that may be applicable | |||||
c) The fishing vessel declared to have caught he fish had authorisation to fish in the area declared | |||||
d) the presence of the fishing vessel in the area of catch declared has been verified according to VMS data | |||||
Flag State confirmation I confirm that the above information is complete, true and correct to best of my knowledge and belief. | |||||
Name and title | Date | Signature | Official Stamp |
PART C: For official use only — to be completed by the Port State | ||||
a Fishing vessels not assigned an IMO (International Maritime Organisation) number shall provide their external registration number. | ||||
b If necessary an additional form or forms shall be used. | ||||
c FAO 3-alpha Species Codes. | ||||
d Product presentations Appendix to Annex XV. | ||||
Name of Port State | Authorisation given | Date | Signature | Stamp |
Yes … No … |
PART A: To be completed by the master of the vessel | ||||||||||||
Name of vessel | IMO Numberb | Radio Call Sign | Flag State | |||||||||
Inmarsat Number | Telefax Number | Telephone Number | E-mail address | |||||||||
Port of landing or transhipment | Estimated Time of Arrival | |||||||||||
Date: | Time (UTC): | |||||||||||
Catch information for donor vessels | ||||||||||||
Name of vessel | IMO Numberb | Radio Call Sign | Flag State | |||||||||
Total catch on board | Catch to be landedc | |||||||||||
Speciesd | Producte | ICES area of catch | Product weight (kg) | Speciesd | Producte | ICES area of catch | Product weight (kg) |
PART B: For official use only — to be completed by the Flag State | |||||
The Flag State of the vessel must respond to the following questions by marking ‘Yes’ or ‘No’ | Yes | No | |||
a) The fishing vessel declared to have caught the fish had sufficient quota for the species declared | |||||
b) The quantities on board have been duly reported and taken into account for the calculation of any catch or effort limitations that may be applicable | |||||
c) The fishing vessel declared to have caught he fish had authorisation to fish in the area declared | |||||
d) the presence of the fishing vessel in the area of catch declared has been verified according to VMS data | |||||
Flag State confirmation I confirm that the above information is complete, true and correct to best of my knowledge and belief. | |||||
Name and title | Date | Signature | Official Stamp |
PART C: For official use only — to be completed by the Port State | ||||
a A separate form shall be completed for each donor vessel. | ||||
b Fishing vessels not assigned an IMO number shall provide their external registration number. | ||||
c If necessary an additional form or forms shall be used. | ||||
d FAO 3-alpha Species Codes. | ||||
e Product presentations as set out in Appendix to Annex XV. | ||||
Name of Port State | Authorisation given | Date | Signature | Stamp |
Yes … No … |