PORT HEALTH OFFICE

MARITIME DECLARATION OF HEALTH

( International Health - Form Regulations 1969 )
( To be rendered by the master of any ship arriving from ports outside national territory )

PORT: Agadir DATE: 28/07/2022

SHIP'S NAME: M/V VISITOR FROM: Las Palmas TO: Algeciras

NATIONALITY: Portugal NAME OF MASTER: FUGIEL, GRZEGORZ JAKUB

NET REGISTERED TONNAGE: 6,006

SANITATION EXEMPTION CERTIFICATE: Issue Date: 03-Jun-22

ISSUED AT: FERROL

NUMBER OF PASSENGERS: NIL NUMBER OF CREW: 13

List of ports of call from commencement of voyage with dates of departure:

LAS PALMAS 27-Jul-22

SANTA CRUZ 26-Jul-22
ALGECIRAS (APM) 24-Jul-22

HEALTH QUESTIONS
Answer
YES / NO
1. Has there been on board during the voyage any case or suspeted case of plague, NO
cholera, yellow fever, smallpox relapsing fever ? Please give particulars

2. Has the plague occurred or been suspected among the rats or mice on board during NO
the voyage? Or has there been any abnormal behaviour / mortality among them ?

3. Has anyone died during the voyage otherwise than as an result os an accident ? NO
Give particulars on the schedule

4. Is there on board, or has there been during thew voyage any case of illness which NO
you suspect to be an infectious nature ?

5. Is there any sick person on board at this moment ? Please give particulars. NO

6. Are you aware of any condition on board which may lead to the infection or the NO
spread of disease ?
I hereby declare that the particulars and answers to the questions given in this
declaration of health are true and correct to the best of my knowledge and belief.

Date: 28-Jul-2022 Signed:

MASTER