INFORMATION TO BE PROVIDED BY SHIPS INTENDING

TO PORT OF IZMIT BAY

m/v “ SCOUT”
FORM A

1) International Ship Security Certificate (ISSC) or Interim ISSC

Issuing Authority : ISSUED UNDER THE PROVISIONS OF THE INTERNATIONAL CODE FOR THE SECURITY OF SHIPS AND OF
PORT FACILITIES (ISPS CODE), UNDER THE AUTHORITY OF THE GOVERNMENT OF THE REPUBLIC OF MOLDOVA BY
MEDITERRANEAN SHIPPING REGISTER

Dates of issued and Expire: 07.09.19 / 06.03.20

The current security level of the ship: “1 LEVEL”
2) The security levels in the previous ten calls at port facilities:

№ Port name UN Security Date of Date of UNLOCODE Port facility

location Level arrival departure (if available)
1. DNIPRO UKRAINE SL=1 01.11.2019 09.11.2019 UA DNI RIVER PORT
2. KHERSON UKRAINE SL=2 11.11.2019 12.11.2019 UA KHE SEA PORT
3. ALIAGA TURKEY SL=1 18.11.2019 20.11.2019 TR ALI SEA PORT
4. SAMSUN TURKEY SL=1 26.11.2019 29.11.2019 TR SSX SEA PORT
5. KHERSON UKRAINE SL=2 04.12.2019 05.12.2019 UA KHE SEA PORT
6. DNIPRO UKRAINE SL=1 07.12.2019 15.12.2019 UA DNI RIVER PORT
7. KHERSON UKRAINE SL=2 18.12.2019 19.12.2019 UA KHE SEA PORT
8. BANDIRMA TURKEY SL=1 26.12.2019 28.12.2019 TR BDM SEA PORT
9. POTI GEORGIA SL=1 07.01.2020 10.01.2020 GE PTI SEA PORT
10. KHERSON UKRAINE SL=2 14.01.2020 26.01.2020 UA KHE SEA PORT

3) SHIP SECURITY OFF : Master

4) Any special or additional security measure taken by ship in any previous port where
it has conduced a ship/port interface during the period covered by previous calls at
port facilities. NIL
a) Measures taken while visiting a port facility located in the territory of a state which is not a
Contracting Government. NIL
b) Any Declarations of Security that were entered into with port facilities or other Ships. NIL

5) Confirmation that appropriate ship procedures were maintained during any Ship-to-
Ship activity during the period by previous ten ports at facilities.
a) Measures taken while engaged in a ship-to-ship activity with a ship flying the flag of a state which
is not a Contracting Government. NIL
b) Measures taken while engaged in a ship-to-ship activity with a ship flying the flag of a
Contracting Government but not required to comply with the provisions of chapter X1-2 and part
A of the ISPS Code. NIL
c) In the event that persons or goods rescued at sea are on board, all known information about such
persons or goods, including their identities when known and the results of any checks run on
behalf of the ship to establish the Security status of those rescued. NIL

26.01.2020

Master of m/v “SCOUT” Y.Kuz’menko