[Section 11 (4) and 11 (5)]

Form of a Declaration of Security between a Ship and a Port Facility

This Declaration of Security is valid from..................... until ....................,for the following

Activities

(list the activities with relevant details)

under the following security levels

Security level(s) for the ship

Security level(s) for the port facility

The port facility and ship agree to the following security measures and responsibilities to ensure compliance with the requirements of Part A of the International Code for the Security of Ships and of Port Facilities.

                                                      The affixing of the initials of the SSO and PFSO     

                                                     done, in accordance with relevant approval plan, by

Activity                                                 The port facility                                     The ship

Ensuring the performance of all security duties.

Monitoring restricted areas to ensure that only authorised personnel have access.

Controlling access to the port facility.

Controlling access to the ship.

Monitoring of the port facility, including berthing areas and areas surrounding the ship. Monitoring of the ship, including berthing areas and areas surrounding the ship.

Handling of cargo.

Delivery of ship's stores.

This form of Declaration of Security is for use between a ship and a port facility. If the Declaration of Security is to cover two ships, this model should be appropriately modified.

Handling unaccompanied baggage.

Controlling the embarkation of persons and their effects.

Ensuring that security communication is readily available between the ship and the port facility.

The signatories to this agreement certify that security measures and arrangements for both the port facility and the ship during the specified activities meet the provisions of chapter XI-2 and Part A of Code that will be implemented in accordance with the provisions already stipulated in their approved plan or the specific arrangements agreed to and set out in the attached annex.

Dated at..........................on the ...................

 (Signature of Ship Security Officer)              (Signature of Port Facility Security Officer)

                                                           Contact Details

                                                (to be completed as appropriate)

           (indicate the telephone numbers or the radio channels or frequencies to be used)

For the port facility                                                                For the ship

Port Facility Security Officer                                            Ship Security Officer

                                                                                                Company

 Port Facility Operator                                                       Company Security Officer