GGD Rotterdam-Rijnmond | Applicationform Ship Sanitation Certificate

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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 te invoice.

Company name 1 ^{input required}

Company name 2

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

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