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1、附件一船舶载运危险/污染危害性货物申报单（包装货物）船舶载运危险/污染危害性货物申报单DeclarationFormHazardousGoodsCarriedByShip（包装货物）（Packaged）申报单编号:船名：航次：口进港上一港（上一出发港）/下一港（下一目的港）：抵离港时间：Shi,sname：VoyageNo:ArrivalPortofPrev/Next:TimeofArrival:国籍：经营人：口出港作业泊位：作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:货物正确运输名称ProperShippingNameofthe
2、Goods类别/性质ClassZProperty危规编号UNNo.装运形式MeansofTransport件数NumberofPackages总重量（千克）WeightinTotal卸货港PortofDischarging装载位置1.ocationofStowage（编号&规格&贝位X-Y-Z&箱内件数&是否拼箱）备注Remarks兹声明根据船舶装载污染危害性货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求，货物资料齐全。申报内容正确无误。Iherebydeclarethat,inaccordancewiththeprovisionsofthesafetransporta
3、tionofsolidbulkcargoesbyshipsandpollutionprevention,thehasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostowageisproperlyplannedaccordingtotherequirements;documentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息（remarks）：附送以下单证、资料：Thefollowingdocuments
4、andinformationaresubmittedinaddition.申报单位：船长/申报人员：船舶/代理人（盖章）MasterZDeclarer:Ship/Agent（Seal）:船长/申报员证书编号：日期：CertificateNo:Date:主管机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPersonsName,Tel,FaxandE-mail:此申报单一式三份，其中两份申报人留持和分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadein
5、tripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.附件二船舶载运危险/污染危害性货物申报单（散装液体）船舶载运危险货物/污染危害性货物申报单DeclarationFormForHazardousGoodsCarriedByShips（散装液体物质）（BulkLiquids）申报单编号：船名：航次：口进港上一港（上一出发港）/下一港（下一目的港）：抵离港时间：Shio,sname:VbvageNo:BerthingPortofDeoarture:Timeof
6、Arrival:国籍：一经管人：一口出海作业泊位：-作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:货物正确运输名称ProperShippingNameofTheGoods种类/性质Class/property规号N6危编UN数量(吨)Quantity(Ton)液货舱编号Numberoftanks液舱惰化(是/否)Tankinerting(yesno)装卸货物温度(eC)CargoHandlingTemPeralUre(C)装/卸货港PortofLoading/Discharging备注remarks本轮液舱中存有下述压载水/污水：T
7、heballast/bilgeWaterremainedintanksOnboard:舱室编号TankNo.水质种类kindsofwater数量Quantity注明该舱室为专用/清洁压载舱或液货舱Indicatingwhetherthetankissegrogted/cleanballasttankorcargotank备注remarks本轮港备在港口进行下述作业，并将按规定另仃申请：Thisshipplanstocarryoutthefollowingoperation(s)inportandapplicationwillbesubmittedseparatelyaccordingtothe
8、relevantprovisions:1.清洗液货舱作业(水洗)口是/口否2.使用清洁剂/添加剂洗舱口是/口否tankwashing(waterwash)YesNotankwashingbydetergent/additivesYesNo3.原油洗舱口是/口否4.驱气作业口是/口否crudeoilwashingYesNogasfreeingYesNo5.向港口接收设施排放含油/有害物质的洗舱水/混合物、预杆吨(M3)disposaloftankwashingwater/watercontainingharmfulsubstances/mixturesintoportreceptionfacil
9、ities,estimatedquantity_tons(M3)兹声明根据船舶装载固体散装货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求，货物资料齐全。申报内容准确无误。Theredeclarethat,ininaccordancewiththeprovisionsofthesafetransportationofsolidbulkcargoesbyshipsandpollutionprevention,thisshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostowagei
10、sproperlyplannedaccordingtotherequirements;Thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息(remarks)：附送以下单证、资料：Thefollowingdocumentsandinformationaresubmittedinaddition:申报单位：船长/申报人员：船舶/代理人(盖章)MasterZdeclarer:Ship/Agent(Seal)船长/申报人员证书编号：日期：CertiticateNo:Date:主管
11、机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：JergencyContactpersonsN肛ne,TFa%andE-mail:此申报单二式三份，其中两份申报人留持和分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.附件三船舶载运固体散装货物声明书船舶载运固体散装货物声明书Declarat
12、ionFormforSolidBulkCargoesCarriedByShip申报单编号:船名：Ship,sName:航次：VoyageNo.:口进港Arrival上一港（上一出发港）/下一港（下一目的港）：PortofPrev/Next:抵离港时间：TimeofArrival:国籍：经营人：口出港作业泊位：作业时间：Nationality:Manager:DepartureBerth:TimeofLoading:散装货物运输名称BulkCargoShippingName组别Group类别Class危规编号UNNo.总重量(吨)WeightinTotal(Ton)卸货港PortofDischa
13、rging装载位置1.ocationofStowage备注Remarks兹声明根据船舶装载固体散装货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求，货物资料齐全。申报内容准确无误。Iherebydeclarethat,inaccordancewiththeprovisionsofthesafetransportationofsolidbulkcargoesbyshipsandpollutionprevention,thisshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostow
14、ageisproperlyplannedaccordingtotherequirements;Thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretrueandcorrect.备注信息(remarks):附送以下单证、资料Thefollowingdocumentsandinformationaresubmittedinaddition.申报单位：船长/申报员：船舶/代理人(盖章)Master/Declarator:Ship/Agent(Seal)船长/申报员证书编号：日期：CertificateNo.:Dat
15、e:主管机关签证栏RemarksbytheAdministration电话号码：审核日期：紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson,sName,TelephoneNo.,Fax,andE-mail:此申报单一式三份，其中两份退申报人留持并分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.中华人民共和国海事局监制附件四危险/污染危害性货物安全适运申报单(包装货物)危险货物/污
