文档介绍:MODEL OF MARITIME DECLARATION OF HEALTH
REPUBLIC OF PANAMA
To pleted and submitted to petent authorities by the masters of ships arriving from foreign ports.
Submitted at the port of ___________________ Date __________________
Name of ship or inland navigation vessel _________________________ Registration / IMO No_______________arriving from________________ sailing to_______________ (Nationality) (Flag of vessel)________________________________ Master’s name_______________________________ Gross tonnage (ship)_________________
Valid Sanitation Control Exemption/ Control Certificate carried on board? Yes_______ No________ Issued at__________ date__________ Re-inspection required? Yes__________ No_________
Has ship/vessel visited an affected area identified by the World anization? Yes________ No_________
Port and date of visit________________________________________
List ports of call mencement of voyage with date of departure, or within past thirty days, whichever is shorter:
___________________________________________________________________________________________________
Upon request of petent authority at the port of arrival, list crew members, passenger or other person who have joined ship/ vessel since international voyage began or within past thirty days, whichever is shorter, is including all ports countries visited in this period ( add additional names to the