LAMPIRAN 3

PK (O) IM.H.04-13/FQ-03

GOVERNMENT OF MALAYSIA
Immigration Act 1959/63
(ACT 155)
Immigration Regulation 1963
(F.L.N 288 1963)
NOTIFICATION
{ REGULATIONS 15(5) }

To,
THE MASTER OF S.S / M.V.…....................................................................................................................
WHEREAS each of the member of the your vessel who are specified in the crew of your vessel who are specified
in the crew list annexed hereto and mark “Annexure A” hold a Seaman’s Identification Card which is deemed by
virtue of the provisions of Regulation 15(4) of the Immigration Regulations 1963 to be a Landing Pass issued to
him under the provisions of Regulations 15(1) of the Regulation:-

YOU ARE HEREBY NOTIFIED that each of the aforesaid members of the crew of your vessel is, by
virtue of his said Seamen’s Identification Card being deemed to be a Landing Pass of aforesaid, Permitted to enter
West Malaysia but subject to the condition that he shall remain within PORT KLANG during the stay of your
Vessel in the port of PORT KLANG.
(DECLARATION BY MASTER OF VESSEL S.S / M.V……………………………………...............................)
In pursuance of Section 22(1) (a) (vi) of the Immigration Act 1959/63.
(This form of Declaration by Master should be complete and delivered to Immigration Authority before
commencing clearance of the vessel)

I, the undersigned, CAPTAIN

………………………………………………………………………………………....

Master of S.S/M.V.
…………………………………………………………………………….....................................

In pursuance of section 22(1) (a) (vi) of the Immigration Act 1959/63, do hereby affirm and declare to the
Immigration Authority that my vessel does not carry any STOWAWAY.

A duplicate of the Notification Reg.15 and Declaration of Stowaway was delivered by me to the Master personally.

Date/ Time @
( For Director Of Immigration Malaysia)
Full Name :
Designation :

I hereby acknowledge receipt of duplicate of the above notification and Declaration

Date
( Signature of the master of S.S / M.V)