Segregated ballast tanks total tonnage (Tankers only)
LIST PORTS VISITED WHILE IN NEW ZEALAND ON THIS VOYAGE (Please record on a separate sheet and attach if additional space is required.)
New Zealand ports visited
Date of arrival
Date of departure
1.
2.
3.
4.
5.
LIST OVERSEAS PORTS EN ROUTE TO PORT OF DESTINATION (Please record on a separate sheet and attach if additional space is required.)
1.
2.
3.
Total number of crew on departure
Total number of crew embarked in New Zealand
Total number of passengers on departure
Total number of passengers embarked in New Zealand
CARGO
Has cargo been loaded onto the craft in New Zealand, whether originating in New Zealand, or transhipped in New Zealand for export? YES □ NO □
If YES, state the number of Outward Cargo Reports intended to be given and the names of the persons who will be giving them.
Please record on a separate sheet and attach if additional space is required.
Number
TANKERS ONLY: Total tonnage of persistent (P) and non persistent (NP) oil carried.
New Zealand ports visited
P oil carried on arrival
P oil loaded
NP oil carried on arrival
NP oil loaded
1.
2.
3.
4.
5.
DECLARATION
I hereby declare this Outward Report, comprising parts A, B, and C, is true and correct.
Signature of Person in Charge
Date
PART B: SUPPORTING DOCUMENTS CHECK LIST
Note: The following documents should be attached to this report (if applicable):
Passenger list attached
YES □ NO □
Transit passenger list attached
YES □ NO □
Craft stores requisitions attached
YES □ NO □
Controlled drugs and firearms list attached
YES □ NO □
Cargo reports attached
Number electronic
Number manual
OFFICIAL USE: Documentation for Outward Report produced and Certificate of Clearance issued.
NZ Gazette 2004, No 142
