Bijlage 2 Regeling bescherming koopvaardij: embarkation Form – ship master

Regeling bescherming koopvaardij

Instruction – Please send the completed form after embarking security guards and armament to the Dutch Coast Guard and the Human Environment and Transport Inspectorate (ccc@kustwacht.nl / MIK-NL@kustwacht.nl / wtbk@ilent.nl) – attach completed form to final voyage report GENERAL INFORMATION Details Notes Name of ship IMO number Call sign Name of master Place and date of embarkation of security team INFORMATION ABOUT THE SECURITY TEAM MEMBERS If possible attach crew list with the following information: Name of maritime security guard Date of birth Address Nationality Passport number INFORMATION ABOUT THE WEAPONS Weapons Details Notes Type of weapons Serial numbers Attach photo of weapon serial numbers Do the weapons match the statement from the ship manager and PMSC? Yes/No INFORMATION ABOUT THE AMMUNITION Ammunition Details Notes Ammunition type (Calibre, FMJ/soft-point) Number of bullets INFORMATION ABOUT THE HELMET CAMERAS Details Notes Brand and type of the helmet cameras Number of helmet cameras INFORMATION ABOUT THE HAND CUFFS Details Notes Hand cuffs available? Number of hand cuffs THE SHIP MASTER DECLARES THAT: Yes Notes Outside the high risk area, the weapons will be stored in the weapons locker in accordance with art. 3.2 BBK An immediate report will be made to the Dutch Public Prosecutor’s Office concerning any incident at sea involving the use of force and I will also inform the Coast Guard and the Human Environment and Transport Inspectorate. a report will be made to the Coast Guard and the Human Environment and Transport Inspectorate about where and when the armed security team disembarks within 48 hours after disembarkment. I have completed this form correctly to the best of my knowledge. Name Date Signature Treedt in werking op het tijdstip waarop de Wet ter Bescherming Koopvaardij in werking treedt.