Form of A Declaration of Security Between A Ship and A Port Facility
Form of A Declaration of Security Between A Ship and A Port Facility
Form of A Declaration of Security Between A Ship and A Port Facility
Declaration of security
This form of Declaration of security is for use between a ship and a port facilitiy. If the Declaration of security is to cover two ships, this model should be appropriately modified.
This Declaration of security is valid from until for the following activities: (List the activities with relevant details) Activity: Details:
under the following security levels Security level(s) for the ship: Security level(s) for the port facilities: The port facility and ship agree to the following security measures and reponsibilities to ensure compliance with the requirements of part A of the International Code for the Security of Ships and of Port facilities.
The affixing of the initials of the SSO or PFSO under these columns indicates that the activity will be done, in accordance with the relevant approved plan by The port facility: The ship:
Monitoring restricted areas to ensure that only authorized personel have access. Controlling access to the port facility
Monitoring of the port facilities, including berthing areas and areas sorrounding the ship. Monitoring of the ship, including berthing areas and areas sorrounding the ship. Handling of cargo.
Ensuring that security communication is readily available between the ship and the port facility. The signatories to this agreement certify that security measures and arrangements for both the port facility and the ship during the specified activities meet the provisions of chapter XI-2 and part A of the Code that will be implemented in the accordance with the provisions already stipulated in their approved plan or the specific arrangements agreed to and set out in the eattached annex. Dated at on the
Name : Title:
Name: Title:
For the port facility: Port facility: Port facility security officer:
Contact details (to be completed as appropriate) (indicates the telephone numbers or the radio channels or frequency to be used) For the ship: Master: test please ignore Ship security test please ignore officer: Company: Kristian Gerhard Jebsen Skipsrederi AS Company security Bolstad, Bjrn officer: