Elektronik Pre-Arrival Notification Of Ship Security

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ePAN version 1.0

⏱️ This form may take 10 minutes to complete. You will need the following information to complete the form:

Particulars of ship and contact details
Arrival voyage information
Security related information
Declarations

📋 Pre-Arrival Notification (PAN)

Owners, Agents or Masters of:

Cargo Export ships / Bulk Carrier
Domestic Vessel Carrier
Cargo Domestic & Import Barge tugboat

⚠️ Important: Must email a duly completed PAN (this form) to ispstubanjetty@sig.id at least 24 hours before arrival of the ship into Jetty. A ship and barge tugboat coming from a nearby port, with less than 24 hours steaming time to Jetty SBI, must immediately on departure from such port complete this form and email to Jetty SBI before arrival into Jetty SBI.

1. Particulars of Ship and Contact Details

* 1. Name of ship Nama Kapal

* 2. IMO No No. IMO

* 3. Call Sign Tanda Panggil

* 4. Type of Ship Tipe kapal

* 5. GT (MT) Berat kotor

* 6. Flag Bendera

If others, please specify flag country Jika lainnya, tuliskan negara bendera

* 7. No of Crew Jumlah crew

* 8. Estimate Time Arrival Perkiraan waktu tiba

* 9. Purpose of Call Maksud kedatangan

If others, please specify purpose Jika lainnya, tuliskan maksudnya

* 10. Name of Anchorage or Port Facility Nama daerah lego jangkar atau fasilitas pelabuhan tempat kapal anda akan berada

* 11. Name of Agent in Indonesia Nama agen di Indonesia

* 12. Agent Contact Kontak agen

Telp/Mobile No.

Fax

2. Security Related Information

* Does your ship possess a valid International Ship Security Certificate (ISSC)? Apakah kapal anda memiliki International Ship Security Certificate (ISSC)?

YES NO

* 15. Current security level of the ship Tingkat keamanan kapal saat ini

* 16. Last 10 ports of call 10 pelabuhan terakhir yang dikunjungi (termasuk tanggal kedatangan/keberangkatan dan tingkat keamanan)

* 17. Were there any special or additional security measures taken? Apakah ada tindakan keamanan khusus atau tambahan yang diambil?

YES NO

If YES, give details Jika YA, jelaskan

* 18. Were there appropriate ship security measures maintained during any ship-to-ship activity? Apakah ada tindakan yang pantas digunakan selama kegiatan interaksi kapal?

YES NO

If YES, give details Jika YA, jelaskan

3. Declarations

* Signature of Owner/Agent/Master/CSO Tanda tangan Pemilik/Agen/Nahkoda/CSO

* Name of Master/Owner/Agent/CSO Nama Nahkoda/Pemilik/Agen/CSO

* Date and Time Tanggal dan Waktu

Date / Tanggal

Time / Waktu

* Present Position Posisi sekarang

Latitude

Longitude

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