ANNEX 2

1. SHIP PARTICULARS

1.1 Name of ship:

1.5 Owner or operator:

1.2 IMO number:

1.6 Distinctive number or letters:

MMSI (Maritime Mobile Service Identity) number:

1.3 Gross tonnage:

1.7 Flag State:

1.4 Type of ship:

Oil tanker

Chemical tanker

Bulk carrier

Container

Other cargo ship

Passenger ship

Ro-ro

Other (specify)

2. PORT AND VOYAGE PARTICULARS

2.1 Location/terminal name:

2.6 Last port where waste was delivered:

2.2 Arrival date and time:

2.7 Date of last delivery:

2.3 Departure date and time:

2.8 Next port of delivery:

2.4 Last port and country:

2.9 Person submitting this form (if other than the master):

2.5 Next port and country (if known):

3. TYPE AND AMOUNT OF WASTE AND STORAGE CAPACITY

Type

Waste to be delivered (m3)

Maximum dedicated storage capacity (m3)

Amount of waste retained on board (m3)

Port at which remaining waste will be delivered

Estimated amount of waste to be generated between notification and next port of call (m3)

MARPOL Annex I – Oil

Oily bilge water

Oily residues (sludge)

Oily tank washings

Dirty ballast water

Type

Waste to be delivered (m3)

Maximum dedicated storage capacity (m3)

Amount of waste retained on board (m3)

Port at which remaining waste will be delivered

Estimated amount of waste to be generated between notification and next port of call (m3)

Scale and sludge from tank cleaning

Other (please specify)

MARPOL Annex II – NOXIOUS LIQUID SUBSTANCES (NLS) (1)

Category X substance

Category Y substance

Category Z substance

OS – other substances

MARPOL Annex IV – Sewage

MARPOL Annex V – Garbage

A. Plastics

B. Food Waste

C. Domestic waste (e.g. paper products, rags, glass, metal, bottles, crockery, etc.)

D. Cooking Oil

E. Incinerator ashes

F. Operational waste

G. Animal carcass(es)

H. Fishing gear

I. E-waste

(1) Indicate the proper shipping name of the NLS involved.

(1)

Type

Waste to be delivered (m3)

Maximum dedicated storage capacity (m3)

Amount of waste retained on board (m3)

Port at which remaining waste will be delivered

Estimated amount of waste to be generated between notification and next port of call (m3)

J. Cargo residues (2) (Harmful to the Marine Environment – HME)

K. Cargo residues (3) (non-HME)

MARPOL Annex VI – Air Pollution related

Ozone depleting substances and equipment containing such substances (4)

Exhaust gas cleaning residues

Other waste, not covered by MARPOL

Passively fished waste

Notes

1. This information shall be used for port State control and other inspection purposes.

2. This form is to be completed unless the ship is covered by an exemption in accordance with Article 9 of Directive (EU) 2019/883

(1) May be estimates. Indicate the proper shipping name of the dry cargo.

(2) May be estimates. Indicate the proper shipping name of the dry cargo.

(3) Arising from normal maintenance activities on board.

(2)

(3)

(4)