船舶载运危险货物申报行政审批申请书.doc

《船舶载运危险货物申报行政审批申请书.doc》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、船舶载运危险货物申报行政审批申请书船舶载运危险货物申报单DeclarationFormDangerousGoodsCarriedByShip（包装/固体散装危险货物）（Packaged/SolidinBulk）船名：航次：进港始发港:抵港时间：Ship’sname：VoyageNo:ArrivalPortofDeparture:TimeofArrival:国籍：经营人：出港作业泊位:装货时间：Nationality:Manager:DepartureBerth:TimeofLoading:货物正确运输名称ProperShip

2、pingNameoftheGoods类别/性质Class/Property危规编号UNNo.装运形式MeansofTransport件数NumberofPackages总重量WeightinTotal卸货港PortofDischarging装载位置LocationofStowage备注Remarks兹声明根据船舶装载危险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,inaccordancewiththeprovisionsofth

3、esafetransportationofdangerousgoodsbyshipsandpollutionprevention,theshiphasmettherequirementsoffitnessforcarryingtheabovedeclaredgoods;Cargostowageisproperlyplannedaccordingtotherequirements;Thedocumentationofthecargoiscompleteandthecontentsofthedeclarationaretruea

4、ndcorrect.附送以下单证、资料：Thefollowingdocumentsandinformationaresubmittedinaddition.船长/申报人员：船舶/代理人（盖章）Master/declarer:Ship/Agent(Seal):船长证书编号/申报人员培训备案编号：日期：CertificateNo:Date:主管机关签证栏RemarksbytheAdministration紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPerson’sName,Tel,FaxandE-mai

5、l: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。Thisdeclarationshouldbemadeintripartite,oneiskeptbytheAdministrationforfile,andtwoforthedeclarerandportoperatorrespectively.船舶载运危险货物申报单DeclarationFormForDangerousGoodsCarriedByShips（散装液体物质）（BulkLiquids）船名：国籍：进港始发港:抵港时间：Ship’s

6、name：Nationality:BerthingPortofDeparture:TimeofArrival:所有人：航次：出港作业泊位:装货时间：Owner:VoyageNo.DepartureBerth:TimeofLoading:货物正确运输名称ProperShippingNameofTheGoods种类/性质Category/property危规编号UNNo.数量Quantity液货舱编号Numberoftanks液舱惰化（是/否）Tankinerting(yes/no)装卸货物温度（℃）CargoHandlingT

7、emperature(℃)装/卸货港PortofLoading/Discharging备注Remarks本轮液舱中存有下述压载水/污水：Theballast/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本轮准备在港口进行下述作业，并将按规定另行申请：Th

8、isshipplanstocarryoutthefollowingoperation(s)inportandapplicationwillbesubmittedseparatelyaccordingtotherelevantprovisions:1.清洗液货舱作业（水洗）□是/□否2.使用