INWARDS CREW REPORT

Approved Form Customs Act 1901 section 64ACB

Notice: The following information, including personal information, is required to be reported under subsections 64ACB(1) and 64ACB(5) of the Customs Act 1901 in order to assess crew for the risk they may present in
relation to the Customs Act 1901, the Migration Act 1958, and any other prescribed law of the Commonwealth. Information provided on this form may be disclosed to a number of agencies including the Department of
Infrastructure, Transport, Regional Development and Communications, the Australian Federal Police, the Australian Criminal Intelligence Commission, the Attorney-General’s Department and the Department of Foreign
Affairs and Trade. Any false or misleading statements may result in penalty action under section 243T or 243U of the Customs Act 1901. Personal information is collected, used, stored and disclosed by Department of
Home Affairs (the Department) in accordance with the Australian Privacy Principles in schedule 1 of the Privacy Act 1988. Further information regarding how the Department, collects, stores, uses and discloses personal
information may be found in form 1442i Privacy notice. More information about how the Department handles personal information can be found in the Department’s Privacy Policy at
https://www.homeaffairs.gov.au/access-and-accountability/our-commitments/plans-and-charters/privacy-policy
Please open this form using Adobe Acrobat Reader. Either type in the fields provided or print this form and complete it using a pen and BLOCK LETTERS. Tick where applicable 3
Intended seaport Date of arrival/departure Vessel name IMO number
/ / Page ........ of ........

Crew details – List in alphabetical order

Surname Given names Travel document Country of issue Date of birth Sex * Country of birth Rating Australian Maritime
number (M/F/X) Crew Visa Holder?
/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No
* M = Male, F = Female, X = Indeterminate / Intersex / Unspecified
If space provided is insufficient, additional pages providing the same data fields should be attached.

Declaration
I, being the Authorised Agent / Master-in-Command declare that all particulars contained in this report are complete, exact and true to the best of my knowledge.
Signature Date
/ /
Form 3B (Design date 02/20) – Page 1
 INWARDS CREW REPORT
Additional page

The following information is required under section 64ACB of the Customs Act 1901 in order to assess crew for the risk they may present in relation to a range of Commonwealth laws.
Information provided on this form may be disclosed to a number of agencies including the Australian Federal Police, the Australian Criminal Intelligence Commission, the Attorney-General’s Page ........ of ........
Department and the Department of Foreign Affairs and Trade.

Crew details – List in alphabetical order

Surname Given names Travel document Country of issue Date of birth Sex * Country of birth Rating Australian Maritime
number (M/F/X) Crew Visa Holder?
/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No

/ / Yes No
* M = Male, F = Female, X = Indeterminate / Intersex / Unspecified
If space provided is insufficient, additional pages providing the same data fields should be attached.

Declaration
I, being the Authorised Agent / Master-in-Command declare that all particulars contained in this report are complete, exact and true to the best of my knowledge.
Signature Date
/ /

Form 3B (Design date 02/20) – Additional page