GGD Rotterdam-Rijnmond | Applicationform Ship Sanitation Certificate

Vertalen

Translate

Use Google to translate this website. We take no responsibility for the accuracy of the translation.

Requests should be sent in as soon as possible through this form.

Please fill out the form completely. Questions marked * are obligatory. A copy of your completed form will be sent to you by email.

Ship details

Name ship ^{input required}

Flag ^{input required}

Registration / IMO-No. ^{input required}

Gross Tonnage GT ^{input required}

Year of Construction ^{input required}

Type of ship ^{input required}

No. of Passengers ^{input required}

No. of Crew Members ^{input required}

Shipping company/agent details

Name Shipping Company / Agent ^{input required}

Phone No. ^{input required}

E-mail Address ^{input required}

Contact Person ^{input required}

Mobile Phone ^{input required}

Company name and Invoice Address

Please enter the complete and correct invoice address.
If you don't, we have to charge you extra.
Name of the ship listed as Captain/owners will already be included on the invoice.

Company name ^{input required}

VAT

Tax/refnr.

Invoice Address

Zip Code

City

Country

Ship Sanitation Certificate inspection information

Date & Time Arrival ^{input required}

Date & Time Departure ^{input required}

Name of Mooring ^{input required}

Port No. ^{input required}

Ship accessible by car ^{input required}

Yes

No

Meer weten over privacy en hoe de GGD met uw persoonsgegevens omgaat? Kijk op ggdrotterdamrijnmond.nl/privacy