船 舶 载 运 固 体 散 装 货 物 申 报 单
Declaration Form for Solid Bulk Cargoes Carried By Ship
船 名： 大唐1
Ship’s Name:
航 次：0001
Voyage No.:
□进港
Arrival
始发港： 宁波港
Port of Departure:
抵港时间： 2011/01/30 1400
Time of Arrival:
国 籍： 中国
Nationality:
经 营 人：象山大唐海运
Manager:
□出港
Departure
作业泊位： 北仑电厂码头1泊位
Berth:
作业时间： 2011/01/30 1530
Time of Loading:
散装货物运输名称
Bulk Cargo Shipping Name
组别
Group
类别
Class
危规编号
UN No.
总 重 量
Weight in Total
卸 货 港
Port of Discharging
装载位置
Location of Stowage
备 注
Remarks
煤（COAL）
A和B
MHB
10000
宁海
1H/2H/3H/4H
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。
I hereby declare that, in accordance with the provisions of the safe transportation of solid bulk cargoes by ships and pollution prevention, this ship has met the requirements of fitness for carrying the above declared goods; Cargo stowage is properly planned according to the requirements; The documentation of the cargo is complete and the contents of the declaration are true and correct.
附送以下单证、资料
The following documents and information are submitted in addition.
主 管 机 关 签 证 栏
Remarks by the Administration
轮船长/申报员:
Master / Declarator: 张三
船长/申报员证书编号: 29-123456
Certificate No.:
船舶/代理人（盖章）
Ship / Agent (Seal)
日期:
Date:
紧急联系人姓名、电话、传真、电子邮箱：
Emergency Contact Person’s Name, Telephone No., Fax, and E-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。
This declaration should be made in tripartite, one is kept by the Administration for file, and two for the declarer and port operator respectively.
中华人民共和国海事局监制
