Arrival		Departure	Page Number
	
1.1	Name of ship
	1.2.	 IMO number	1.3.	 Call sign	
1.4.	 Voyage number	2.  Port of arrival/departure
	3.  Date of arrival/departure
	4.  Flag State of ship
	
5.  Family name, given names	6.  Nationality	7.  Date and place of birth	8.  Type of identity or travel document	9.  Serial number of identity or travel document	10.  Port of embarkation	11.  Port of disembarkation	12. Transit passenger or not	

								

								

								
13.  Date and signature by master, authorized agent or officer