CREW7

UK P&I Club
THE ATTACHED WORKBOOK CONTAINS A SELECTION OF INTERNATIONAL (IMO RECOGNISED) AND UNITED STATES OF AMERICA PORT ENTRY FORMS WHICH SHOULD BE USEFUL TO ALL MASTERS. The format of the workbook allows these forms to be easily filled in by computer on board and then to be printed as required for any port entry. Some countries may require other special forms which are not set out here. REMEMBER: Make a copy of the spreadsheet to your hard disk and do not save information to the blank provided. To print these instructions for reference, ensure your printer is connected and that the paper size is set correctly. For this go to Print Preview and check the size by clicking the settings command. Now close the preview and press the Print icon.
USE OF THE FORMS 1 Go to the tab marked 'Data'. Follow the columns and enter the crew information as required. Information from this data is sent directly to the other worksheets, so be careful to complete this section acurately and to number each entry as required in the first column. This data base can later be used to include other items and allow new forms to be inserted into the workbook for both ISM and Outside inspection purposes (i.e. Port State Control, Class, Flag State, SIRE, CDI and UK Club Loss Prevention). Fill in by hand only the boxes shaded pale blue, do not change the contents of any other box (this applies to all sheets in the workbook). For the forms to function correctly you must number each crew member in the 'Data' sheet. 2 Now go to tab marked 'Info'. Fill in all the boxes as required by the sheet as these will then automatically enter the required information to both the International and USA forms. This sheet can also be printed to give information to port authorities if so desired. 3 Follow through and insert information to each sheet as required. 4 Where United States forms are required to be in alphabetical order this can easily be achieved using the following means: 1. Go to 'Data', and select the cell B1, top of the column marked 'SURNAME'. 2. Now click on the icon A/Z in the toolbar at the top. All information in the spreadsheet will go into the correct alphabetical order, thus importing to the US Crewlist and US Effects Declaration correctly. 5 To return the 'Data' sheet to normal order for International forms: 1. Select cell A1, top of column marked 'No.' 2. Now again click the icon A/Z in the toolbar at the top. All information is returned to the original entered order. PRINT CONTROLS 6 Each sheet is already set up to print as a single page on the correct size paper. All International forms are set to print as a single A4 size page and those for US forms as either Legal or Letter size as appropriate. 7 To make the double sided originals required, i.e. US Crew List, US Passenger List, or US Clearance documents, print the back page as appropriate onto the reverse of the previously printed front page. 8 Back 1300 refers to the clearance document only. The new I418 form has no back page, is printed as the number of pages required by the additional instructions in the spreadsheet before the forms.
No.
SURNAME
FIRST NAME & INITIAL
FULL NAME
RANK
NATIONALITY
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
VLASOV YERYOMENKO RYBCHUK STARODUB KORCHYNSKY SYZONENKO SAVCHUK LYSENKO BAKHIN KONONOV BRATUKHIN BAYGILDIN POPADYUK HUBRIY ZARVA KOBLYK POZHYDAYEV NITOCHKIN OMELCHENKO SOBIESZCZANSKI JANOWSKI PARTASOV KIRIN CHEKOV
MYKHAYLO MYKOLA ANDRIY MYKHAYLO VIKTOR EDUARD VOLODYMYR VOLODYMYR VASYL SERGIY SERGIY IGOR VITALIY YEVHEN IGOR MYKHAYLO SERHIY OLEG ANATOLIY ZBIGNIEV TOMASZ ANATOLIY OLEKSIY OLEKSANDR
VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL KONONOV SERGIY BRATUKHIN SERGIY BAYGILDIN IGOR POPADYUK VITALIY HUBRIY YEVHEN ZARVA IGOR KOBLYK MYKHAYLO POZHYDAYEV SERHIY NITOCHKIN OLEG OMELCHENKO ANATOLIY SOBIESZCZANSKI ZBIGNIEV JANOWSKI TOMASZ PARTASOV ANATOLIY KIRIN OLEKSIY CHEKOV OLEKSANDR PORT ARRIVED FROM/DESTIN PORT OF ARRIVAL/DEP DATE
MASTER CH.OFF. 2 OFF. 3 OFF CH.ENG. 2 ENG. 3 ENG. 4 ENG. ELECTR. BOSUN A/B A/B A/B O/S O/S OILER OILER OILER FITTER FITTER FITTER COOK M/M M/M
UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE RUSSIAN UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE POLISH POLISH UKRAINE UKRAINE UKRAINE
Durban Sankt Peterburg 9/9/2007
United States Coast Guard

National Vessel Movement Center
D.O.B
PLACE OF BIRTH
PASS NR.
SEAMAN BOOK NO. JOINED DATE PLACE JOINED US VISA EXPIRY
16/01/1964 27/04/1950 12/03/1972 06/08/1972 06/10/1939 16/11/1974 28/07/1971 06/03/1978 28/12/1959 27/09/1962 17/01/1965 28/07/1967 16/01/1983 14/05/1979 28/11/1987 23/11/1984 03/02/1971 14/05/1975 08/11/1963 17/03/1950 10/10/1968 17/07/1969 17/04/1979 18/12/1980
UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE GERMANY GEORGIA UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE KAZAKHSTAN UKRAINE
UKRAINE UKRAINE UKRAINE
AB310289 AB285863 AB016776 AB315494 AB331888 AB276386 AB324698 AB181048 AB328721 AB284428 AB278158 AB336432 AB072589 AB302133 AB356561 AB352937 AB292259 AB139153 AB311287 227431 210324 AB344619 AB072051 AB332177
17/07/2007 29/05/2007 7/08/2007 29/05/2007 7/08/2007 15/03/2007 15/03/2007 15/03/2007 16/03/2007 7/08/2007 15/03/2007 15/03/2007 15/03/2007 15/03/2007 7/08/2007 15/03/2007 15/03/2007 15/03/2007 16/03/2007 20/03/2007 20/03/2007 15/03/2007 15/03/2007 15/03/2007
Dahej Antofagasta Durban Antofagasta Durban Valletta Valletta Valletta Valletta Durban Valletta Valletta Valletta Valletta Durban Valletta Valletta Valletta Valletta Sfax Sfax Valletta Valletta Valletta
VISA TYPE YELLOW FEVER EXPIRY
06-Feb-13 28-Aug-16 29-Jul-13 18-May-17 14-Apr-16 05-May-16 14-Nov-16 28-Mar-15 04-Jun-13 14-Apr-15 15-Dec-16 03-Aug-08 27-Feb-16 07-Dec-16 02-Jul-17 15-Jun-16 16-Apr-14 13-Jun-11 08-Jun-08
21.Jul-09 10-Apr-13 08-Feb-16
INFORMATION
Vessel's Name Vessel's Nationality Voyage Number Master's Name Register Number/IMO Number Number of Crew (inc. Master) Call Sign Gross Tonnage Nett Tonnage Port of Arrival/Departure : Date of Arrival Arrival Draft Vessel Built, Port/Country Year Built Agent's Name & Address Agent's phone number Vessel Trade Group (back 1300) Vessel Type (back 1300) Owner's Name & Address Operator's Name Operator's Address
"ROGUE" VALLETTA 8 O.GRITSENKO 6608/8021323 22 9HUF8 13432 8232

November 23, 2005 9,3 m Shin Kurushima Dockyard Co, Japan December 23, 1980 Silver Line 02
DRY CARGO
BUNKERS
Heavy Fuel Oil (120cst) MT Marine Diesel Oil MT Lubrication Oils/Grease MT Fresh Water Domestic MT Tank Cleaning F.Water MT 340 120 15 70 230
USA ITINERARY
Next Port Date of Arrival Agent ORDER
Loadline Cert Expires? Cert. Of Financial Responsibility No. Cert. Of Financial Responsibility expires:. Period of Stay - Days Cargo Cargo B/L figure - Metric Tonnes
March 1, 2005 849018-03 January 14, 2006 10 logs and sawn timbers 14957.7
AOSTA SHIPPING Co.Ltd. MARITEAM SERVICES INC.
6 RIZARIOU Str.HALANDRI,ATHENS,13233 GREECE
PORTS of CALL LIST

Port and Country Last Port 2nd last 3rd last 4th last 5th last 6th last 7th last 8th last 9th last 10th last 11th last 12th last 13th last 14th last NOVOROSSIYSK, RUSSIA ALEKSANDRIA, EGYPT TARANTO, ITALY PTA. DA MADEIRA, BRAZIL NEW ORLEANS, USA CORPUS CHRISTI, USA VARNA, BULGARIA ODESSA, UKRAINE TRIESTE, ITALY VALLETTA Date of Arrival 07-Nov-06 01-Dec-06 19-Dec-06 06-Jan-07 18-Jan-07 24-Jan-07 19-Feb-07 28-Feb-07 09-Mar-07 14-Mar-07 Date of Departure 26-Nov-06 17-Dec-06 23-Dec-06 07-Jan-07 21-Jan-07 27-Jan-07 24-Feb-07 03-Mar-07 12-Mar-07 17-Mar-07
M/V "ROGUE"
DATE:
9/9/2007
Port of registry :VALLETTA, MALTA
PORT:
Sankt Peterburg
LIST PORT OF COLL PORTS OF CALL LIST
No. 1 2 3 4 5 6 7 8 9 10
Port
and
Country
Date of arrival 07-Aug-07 26-July-07 17-July-07 26-June-07 02-June-07 30-May-07 28-May-07 19-May-07 30-Apr-07
Date of departure 10-Aug-07 26-July-07 22-July-o7 27-June-07 02-June-07 31-May-07 30-May-07 23-May-07 01-May-07
DURBAN OFF COLOMBO DAHEJ DURBAN PTA.CHUNGO CALETA COLOSO ANTOFAGASTA GUAYAQUIL SAN LORENZO
Purpose of call bunkering loading bunkering discharging bunkering loading loading loading discharging loading
Master of the m/v " ROGUE "___________________________ VLASOV MYKHAYLO
IMO CREW'S EFFECTS DECLARATION
1.Name of ship
2.Effect wihc are dutiable or subject to prohibition ands and ristricts Sigarets Tobaco Spirits Gold 6.Rank or rating MASTER 7.Personal effects
"ROGUE"
3.Nationality of ship
VALLETTA
4.No 5.Family name,given name
1 VLASOV MYKHAYLO
2 YERYOMENKO MYKOLA
CH.OFF.
3 RYBCHUK ANDRIY
2 OFF.
4 STARODUB MYKHAYLO
3 OFF
5 KORCHYNSKY VIKTOR
CH.ENG.
6 SYZONENKO EDUARD
2 ENG.
7 SAVCHUK VOLODYMYR
3 ENG.
8 LYSENKO VOLODYMYR
4 ENG.
9 BAKHIN VASYL
ELECTR.
10 KONONOV SERGIY
BOSUN
11 BRATUKHIN SERGIY
A/B
12 SOLOMAKHIN PAVLO
A/B
13 POPADYUK VITALIY
A/B
Date and signature by Master, authorized agent or officer
Port of PORT: Arrival/Departure :

Sankt Peterburg
Master
VLASOV MYKHAYLO
1.Name of ship :
2.Effect wihc are dutiable or subject to prohibition ands and ristricts Sigarets Tobaco Spirits Gold 6.Rank or rating O/S 7.Personal effects
"ROGUE"
3.Nationality of ship :
VALLETTA
14 HUBRIY YEVHEN
15 ZARVA IGOR
O/S
16 KOBLYK MYKHAYLO
OILER
17 POZHYDAYEV SERHIY
OILER
18 NITOCHKIN OLEG
OILER
19 OMELCHENKO ANATOLIY
FITTER
20 SOBIESZCZANSKI ZBIGNIEV
FITTER
21 JANOWSKI TOMASZ
FITTER
22 PARTASOV ANATOLIY
COOK
23 KIRIN OLEKSIY
M/M
Port of Arrival
MASTER
GRITSENKO OLEG
Page 1 of 2
8.Signature
Page 2 of 2
8.Signature
GRITSENKO OLEG
TELEPHONE CARDS LIST

Page 1 of 1 1.Name of ship 2.Currency
"ROGUE"
VALLETTA
PCS
4.No 5.Family name,given name 6.Rank or rating
DATE
8.Signature
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL KONONOV SERGIY BRATUKHIN SERGIY BAYGILDIN IGOR POPADYUK VITALIY HUBRIY YEVHEN ZARVA IGOR KOBLYK MYKHAYLO POZHYDAYEV SERHIY NITOCHKIN OLEG OMELCHENKO ANATOLIY SOBIESZCZANSKI ZBIGNIEV JANOWSKI TOMASZ PARTASOV ANATOLIY KIRIN OLEKSIY CHEKOV OLEKSANDR
VLASOV MYKHAYLO
Port of Arrival/Departure :
LIST OF CREWS ADVANCE

Page 1 of 1 1.Name of ship and Nationality of ship 2.Currency
"ROGUE", VALLETTA
3.Port and date
Sankt Peterburg
9/9/2007
USD
4.No 5.Family name,given name 6.Rank or rating 8.Signature
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL KONONOV SERGIY BRATUKHIN SERGIY BAYGILDIN IGOR POPADYUK VITALIY HUBRIY YEVHEN ZARVA IGOR KOBLYK MYKHAYLO POZHYDAYEV SERHIY NITOCHKIN OLEG OMELCHENKO ANATOLIY SOBIESZCZANSKI ZBIGNIEV JANOWSKI TOMASZ PARTASOV ANATOLIY KIRIN OLEKSIY CHEKOV OLEKSANDR TOTAL SUM (USD):
VLASOV MYKHAYLO
CREW'S CURRENCY DECLARATION

Page 1 of 1 1.Name of ship 2.Currency
"ROGUE"
EURO
6.Rank or rating
USD
VALLETTA
OTHER CURRENCY
8.Signature
1 VLASOV MYKHAYLO 2 YERYOMENKO MYKOLA 3 RYBCHUK ANDRIY 4 STARODUB MYKHAYLO 5 KORCHYNSKY VIKTOR 6 SYZONENKO EDUARD 7 SAVCHUK VOLODYMYR 8 LYSENKO VOLODYMYR 9 BAKHIN VASYL 10 KONONOV SERGIY 11 BRATUKHIN SERGIY 12 BAYGILDIN IGOR 13 POPADYUK VITALIY 14 HUBRIY YEVHEN 15 ZARVA IGOR 16 KOBLYK MYKHAYLO 17 POZHYDAYEV SERHIY 18 NITOCHKIN OLEG 19 OMELCHENKO ANATOLIY 20 SOBIESZCZANSKI ZBIGNIEV 21 JANOWSKI TOMASZ 22 PARTASOV ANATOLIY 23 KIRIN OLEKSIY 24 CHEKOV OLEKSANDR
50
263 Grv of Ukraine
NIL 26 NIL NIL NIL NIL NIL NIL NIL NIL NIL
NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL
NIL NIL NIL NIL NIL NIL NIL NIL NIL
NIL
NIL NIL
NIL NIL
NIL NIL NIL NIL

14 Peso of Argentina; 4000 Peso of Chile; 100 Grv of Ukraine
NIL NIL
Master
VLASOV MYKHAYLO
Port of Arrival/Departure : 9/9/2007
Sankt Peterburg

1.Name of ship 2.Effect which are dutiable or subject to prohibition and restricts
"ROGUE"
Videorec/DVD players
VALLETTA
TV / LCD Monitor PC/Lap Tops Mob.Phones
Radio/Taperecorders
Videocam.
Photocam
Sigarettes
6.Rank or rating
Watches
1 1 NIL NIL 1 NIL 1 1 1 1 NIL NIL NIL NIL 1 1 1 1 1 NIL
Spirits
Gold
7.Personal effects Clothing and Personal Effects
1 VLASOV MYKHAYLO 2 YERYOMENKO MYKOLA 3 RYBCHUK ANDRIY 4 STARODUB MYKHAYLO 5 KORCHYNSKY VIKTOR 6 SYZONENKO EDUARD 7 SAVCHUK VOLODYMYR 8 LYSENKO VOLODYMYR 9 BAKHIN VASYL 10 KONONOV SERGIY 11 BRATUKHIN SERGIY 12 BAYGILDIN IGOR 13 POPADYUK VITALIY 14 HUBRIY YEVHEN 15 ZARVA IGOR 16 KOBLYK MYKHAYLO 17 POZHYDAYEV SERHIY 18 NITOCHKIN OLEG 19 OMELCHENKO ANATOLIY 20 SOBIESZCZANSKI ZBIGNIEV 21 JANOWSKI TOMASZ 22 PARTASOV ANATOLIY 23 KIRIN OLEKSIY 24 CHEKOV OLEKSANDR
MASTER CH.OFF. 2 OFF.
200
NIL
NIL
NIL
NIL
NIL
NIL
NIL
Clothing and Personal Effects 200 1 1 1 1 NIL NIL 1 NIL NIL
Clothing and Personal Effects
3 OFF CH.ENG.
200
NIL
NIL
NIL
NIL
NIL
NIL
2 ENG. 3 ENG. 4 ENG. ELECTR. BOSUN
200
NIL
NIL
NIL
NIL
NIL
NIL
Clothing and Personal Effects 200 NIL NIL NIL 1 NIL NIL 1 NIL 1
Clothing and Personal Effects NIL NIL NIL NIL 1 NIL NIL 1 NIL 1
Clothing and Personal Effects 200 NIL NIL NIL 1 NIL NIL NIL NIL NIL
A/B A/B A/B O/S O/S
200
NIL
NIL
NIL
NIL
NIL
NIL
Clothing and Personal Effects 200 NIL NIL NIL NIL NIL NIL NIL NIL NIL
Clothing and Personal Effects NIL NIL 1 NIL 1 NIL 1 NIL NIL NIL
Clothing and Personal Effects 200 NIL NIL NIL 1 NIL NIL NIL NIL NIL
OILER OILER OILER FITTER FITTER FITTER COOK M/M M/M
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL
Clothing and Personal Effects NIL NIL NIL NIL NIL NIL NIL NIL NIL
Clothing and Personal Effects 200 NIL NIL NIL 1 1 1 NIL NIL NIL
Clothing and Personal Effects 200 NIL 1 1 1 NIL NIL NIL NIL NIL
Clothing and Personal Effects 200 NIL 1 NIL 1 NIL 1 NIL NIL NIL
Clothing and Personal Effects 200 NIL NIL NIL 1 NIL 1 NIL NIL NIL
Clothing and Personal Effects NIL NIL NIL 1 2 NIL NIL NIL NIL 1
Clothing and Personal Effects NIL NIL NIL NIL 1 1 1 NIL 1 NIL
Clothing and Personal Effects 200 NIL NIL NIL 1 NIL NIL 1 NIL NIL
Master
VLASOV MYKHAYLO
Port of Arrival/Departure : 9/9/2007
Sankt Peterburg
Page 1 of 1
8.Signature
MARITEAM SERVICES INC.
FORM CODE:
CR/5
CREW
Arrival:
1. Name of Vessel 2. Port of Arrival/Departure:
LIST
Departure:
3. Date of Arrival/Departure
Page No.1
"ROGUE"
4. Nationality of Ship
Sankt Peterburg
5. Port Arrived From / Port of destination:
9/9/2007
12.Seaman Book No. or passport No. 12.Date and Place of. singing on
VALLETTA
7.No 8: Family Name, given Names 9. Rank/Rate
Durban
10. Nationality 11. Date of birth
1 2 3 4 5 6 7 8 9
VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL
UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE RUSSIAN UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE POLISH POLISH UKRAINE UKRAINE UKRAINE
16/01/1964 27/04/1950 12/03/1972 6/08/1972 6/10/1939 16/11/1974 28/07/1971 6/03/1978 28/12/1959 27/09/1962 17/01/1965 28/07/1967 16/01/1983 14/05/1979 28/11/1987 23/11/1984 3/02/1971 14/05/1975 8/11/1963 17/03/1950 10/10/1968 17/07/1969 17/04/1979 18/12/1980
AB310289 AB285863 AB016776 AB315494 AB331888 AB276386 AB324698 AB181048 AB328721 AB284428 AB278158 AB336432 AB072589 AB302133 AB356561 AB352937 AB292259 AB139153 AB311287 227431 210324 AB344619 AB072051 AB332177
10 KONONOV SERGIY 11 BRATUKHIN SERGIY 12 BAYGILDIN IGOR 13 POPADYUK VITALIY 14 HUBRIY YEVHEN 15 ZARVA IGOR 16 KOBLYK MYKHAYLO 17 POZHYDAYEV SERHIY 18 NITOCHKIN OLEG 19 OMELCHENKO ANATOLIY 20 SOBIESZCZANSKI ZBIGNIEV 21 JANOWSKI TOMASZ 22 PARTASOV ANATOLIY 23 KIRIN OLEKSIY 24 CHEKOV OLEKSANDR
7/17/2007 Dahej 5/29/2007 Antofagasta 7/08/2007 Durban 5/29/2007 Antofagasta 8/7/2007 Durban 3/15/2007 Valletta 3/15/2007 Valletta 3/15/2007 Valletta 3/16/2007 Valletta 8/7/2007 Durban 3/15/2007 Valletta 3/15/2007 Valletta 3/15/2007 Valletta 3/15/2007 Valletta 07.08.2007 Durban 3/15/2007 Valletta 3/15/2007 Valletta 3/15/2007 Valletta 3/16/2007 Valletta 3/20/2007 Sfax 3/20/2007 Sfax 3/15/2007 Valletta 3/15/2007 Valletta 3/15/2007 Valletta
12. Date and signature by Master, authorised Agent or Officer.
Master of m/v "Rogue"

Form Code:CR-5
M. VLASOV
Effective:01Page May 1/1 2006
Page:1/1 File no.:VS-D-19 File / HO-CR-02 no: C-1
Revision 10
SHIP'S STORES DECLARATION

Arrival
1. Name of ship: 2. Port of arrival/dep.
Departure
3. Date of arrival/dep.
Page No.
1 of 1
"ROGUE" VALLETTA 24
7.Period of stay
Sankt Peterburg
5. Port arrived from/Port of destination 8. Place of storage
9/9/2007
4..Nationality of ship: 6. Number of persons onboard
Durban
RESPECTIVE STORE ROOMS
9. Name of article DECK Ammunition, 38 cal. Revolver, 38 cal Rope, Fibre - other than moorings Spare wire ropes (m) Rope, Wire- other than moorings Mooring ropes ENGINE Fuel Oil - Tons Metric Diesel Oil - Tons Metric Lubrication Oil - Ltrs Fresh Potable Water - Tons Metric STEWARD Cereal & Pasta - inc rice + flour, etc. Coffee Dairy Eggs Fish - Frozen, fresh & canned Fruit - Fresh, dried &canned Meat - Fresh, canned & salt Poultry Vegetables - Fresh, frozen, can & Dry Sugar Cooking Oil Tea Soft drinks (cases) Mineral water (cases) Salt GENERAL Engine Room Chemicals Detergents & Soap Grease Kerosene & Solvents Paint and additives Deck Chemicals Rags BONDED Cigarettes-all types (cartons) Spirits - all types (bottles) Wines (bottles) Beer (cases) CABIN DVD/VHF/AUDIO Sattelite system Computers TV Video/CD Copy machine PYROTECHNICS Bridge Rocket parachute flares Red hand flares Buoyant smoke signal Line throwing apparatus Life Boats (port / stbd) Rocket parachute flares Red hand flares Buoyant smoke signal
10. Quantity NIL NIL 2350 686 3700 4100
11. For official use
386 kg 20,600 kg 176 ltr + 38 kg 940 pcs 147 kg 176 kg 875 kg 204 kg 334 kg 235 kg 145 kg 10,800 kg 27 15 64 kg 888 ltr 90,51 kg 80 kg 140 ltrs 1045 ltrs nil 100 kg 15 nil nil 1 3/5/1 pcs 1 set 10 (2 not in use) pcs 8(1 not in use) pcs 137 / 93 pcs
4 (one not in use) pcs
12 pcs 12 pcs 2 pcs 4 pcs 8 pcs 12 pcs 4 pcs
Also such broken and sundry stores as linen, crockery, silver, spare parts, tools, instrument hospital supplies and slop chest stores as required by law and/or necessary for the safe and efficient navigation of the vessel. Also all spares required under IMO and Bahamian Regulations for the safe operation of the vessel per spares inventories on board
12. Date and Signature by master, authorized agent or officer.
VLASOV MYKHAYLO
CUSTOMS FORM
VACCINATION LIST
(Name of Shipping Line or Agent)
Arrival:
1. Name of Vessel
Departure:
3. Date of Arrival/Departure 9/9/2007 11.Yellow Fever Expire Date. 06-Feb-13 28-Aug-16 29-Jul-13 18-May-17 14-Apr-16 05-May-16 14-Nov-16 28-Mar-15 04-Jun-13 14-Apr-15 15-Dec-16 03-Aug-08 27-Feb-16 07-Dec-16 02-Jul-17 15-Jun-16 16-Apr-14 13-Jun-11 08-Jun-08 03.Mar-09 08-Jun-09 21.Jul-09 10-Apr-13 08-Feb-16
2. Port of Arrival/Departure: Sankt Peterburg 5. Port Arrived From / Destination: Durban 9. Rank/Rate 10. Nationality MASTER CH.OFF. 2 OFF. 3 OFF CH.ENG. 2 ENG. 3 ENG. 4 ENG. ELECTR. BOSUN A/B A/B A/B O/S O/S OILER OILER OILER FITTER FITTER FITTER COOK M/M M/M UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE RUSSIAN UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE UKRAINE POLISH POLISH UKRAINE UKRAINE UKRAINE
"ROGUE"
4. Nationality of Ship VALLETTA 7.No 8: Family Name, given Names 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL KONONOV SERGIY BRATUKHIN SERGIY BAYGILDIN IGOR POPADYUK VITALIY HUBRIY YEVHEN ZARVA IGOR KOBLYK MYKHAYLO POZHYDAYEV SERHIY NITOCHKIN OLEG OMELCHENKO ANATOLIY SOBIESZCZANSKI ZBIGNIEV JANOWSKI TOMASZ PARTASOV ANATOLIY KIRIN OLEKSIY CHEKOV OLEKSANDR
12. Date and signature by Master, authorised Agent or Officer.
9/9/2007
Master of the m/v "ROGUE "
____________
VLASOV MYKHAYLO
Maritime Declaration of Health

Port of : Name of Ship: Nationality :
Sankt Peterburg
Date: From : Durban
9/9/2007 To: Sankt Peterburg
"ROGUE" VALLETTA
Net Registered Tonnage : Deratting or Deratting Exemption Cert.:
13807
Gross Tonnage: Exemption Issued at :
23275 Dated: 22-Mar-07 SFAX.TUNIS
List of ports of call from commencement of voyage with dates of departure :

DURBAN 27.06.07,DAHEJ 22.07.07, OFF COLOMBO 26.07.07, DURBAN 10.08.07
Health Questions
1. Has there been on board during the voyage* any case of plague, cholera, yellow fever, small pox, typhus or relapsing fever? Give particulars in the schedule. 2. Has plague occured or been suspected among the rats or mice on board during the voyage* or has there been an abnormal motality among them? 3. Has any person died on board during voyage* otherwise than as a result of accident? Give particulars in schedule. 4. Is there on board or has there been during the voyage* any case of disease which you suspect to be of infectious nature? Give particulars in schedule. 5. Is there any sick person on board now? Give particulars in schedule. NOTE: In absence of a surgeon, the Master should regard the following symptoms as ground for suspecting the existence of disease of an infectious nature ; fever accompanied by prostration or persisting for several days, or eruption with or without fever; severe diarrhoea with symptoms of collapse; jaundice accompanied by fever. 6. Are you aware of any other conditon on board which may lead to infections or the spread of disease ?
Yes or No
No No No No No
No
I here by declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief.
Date :
9/9/2007
M A S T E R:
VLASOV MYKHAYLO
* If more than four weeks have elapsed since the voyage began, it will suffice to give particulars for the last 4 Weeks.
Carrier Instructions: Completing & Processing the Revised Form I-418 (United States Passenger/Crewlist) 1. Passengers, Supernumeraries and Stowaways a) Provide all requested information on the upper half of the form, including the vessels proposed itinerary in the United States. b) Alphabetically list each passenger, supernumerary or stowaways: Given Name, First Name and Initial, Date of Birth, and Nationality & Document Number, as requested. c) If not all passenger names can be listed on page 1 of the form, continue to page 2 d) Deliver complete passenger list to U.S. Public Health Service, U.S. Immigration & Naturalization Service, and two copies to the U.S. Customs Service. 2. Arriving Crewmen a) Provide all requested information on the upper half of the form, including the vessels proposed itinerary in the United States, with related agent names and addresses (this will aid the Service in determining the responsible departure agent in the event that an updated copy of the I-418 is not received or not properly completed after departure). b) Check the Crew List box. c) Alphabetically list each crewmans Given Name, First Name and Initial, Date of Birth, Nationality and Document Number, and Position or Title, as requested. d) If not all crew names can be listed on page 1 of the form, continue to page 2 and 3 as appropriate. e) Deliver complete crew list to U.S. Public Health Service, U.S. Immigration & Naturalization Service, and two copies to the U.S. Customs Service. f) An immigration officer will designate the inspection status of each crewman, assign a unique I-418 Receipt Number to the form, and return a copy of the form to the master and/or agent. This is the traveling copy, to be updated while the vessel is in the United States. 3. Crew Who Join or Separate in the United States a) If a crewman separates from the vessel while in the United States, record on the traveling copy the separation date in the Date Separated column for that crewman (note that INS must give prior authorization for discharge). b) If a crewman joins the vessel while it is in the United States, add to the traveling copy that crewmans information at the next available blank line of the crew list and place the appropriate date in the Date Joined column for that crewman. 4. Departure Crew List a) If the form has been appropriately annotated throughout the vessels time in the United States, all crew changes should already be reflected on the traveling copy. Confirm that all changes have been recorded. b) When the vessel departs, complete the Summary of Departure section. c) Provide one complete list (whether or not there have been crew changes to the Immigration and Naturalization Service at the port of departure.
U.S. Department of Justice Immigration and Naturalization Service

departs the United States.
Passenger List - Crew List
Prior to arrival in the United States, complete a separate form a) working crew; and b) passengers and supernumeraries. In addition to its initial completion,the crew list shall be updated to reflect crew changes and other relevant activity (or lack thereof) until the vessel Vessel Name:
"ROGUE"
Nationality:
VALLETTA
Official Number:
6608/8021323 07.09.2003
Last foreign port (Place & Country): SANTA MARTA , COLOMBIA Date of Arrival in U.S.:
Date sailed from foreign:
12.09.2003 Arrival Port: NEW ORLEANS
# of Crew (including Master): 22 # of Passengers: NIL
Agent at Arrival (Name & Address):
BLUE WATER SHIPPING COMPANY FAX:504-4558650

(Provide applicable INA Section 258 Exemption):
Will crew perform longshore work while vessel is in the United States? [ X ] NO [ ] YES
PROPOSED ITINERARY
Next U.S. Port(s) Arrival Date Vessel Agent (Name & Address)
PASSENGER LIST
X CREW LIST - Page 1 of 2
List individuals alphabetically. Crew who join the vessel subsequent to its arrival while in the United States must be added to the original list and the appropriate date recorded in the 'Date Joined' column. The 'Date Separated' column must be used when a listed crewman is separated from the vessel while it is in the . Unated States.Any crewman designated as "REFUSED" in the 'Government Use Only' column is to be detained on the vessel at all times.
Family Name
First Name & Initial
Date of Birth
Nationality/ Document #
Position or Title
(Crew Only)
Date Joined
(Crew Only)
Date Separated
(Crew Only)
Inspection Status (INS Use Only)

Checked box indicates subsequent parole
UKRAINE VLASOV YERYOMENKO RYBCHUK STARODUB KORCHYNSKY SYZONENKO SAVCHUK LYSENKO BAKHIN MYKHAYLO MYKOLA ANDRIY MYKHAYLO VIKTOR EDUARD VOLODYMYR VOLODYMYR VASYL
01/16/64
UKRAINE
MASTER CH.OFF. UKRAINE 2 OFF. UKRAINE 3 OFF UKRAINE CH.ENG. UKRAINE 2 ENG. UKRAINE 3 ENG. UKRAINE 4 ENG. UKRAINE ELECTR.
07/17/07 05.08.03 27.06.03 27.06.03 08/07/07 27.06.03 05.08.03 27.06.03 05.08.03

X CONTINUED
04/27/50 03/12/72 08/06/72 10/06/39 11/16/74 07/28/71 03/06/78 12/28/59
I-418 Receipt Number (POE - YYMMDD - Stamp # - Military Time)
RECEIPT FOR CREW (INS Use Only). I-418 Receipt Number at right indicates that the Immigration and Naturalization Services has received the CREW LIST containing the names of all members of crew, including Master, on board said vessel at time of its arrival.
INS Port of Arrival (address):
SUMMARY OF DEPARTURE
Vessel Agent (at Departure): Following this vessel's departure from the United States, ensure that crew list reflects all crew additions and separations and is promptly submitted to the Immigration and Naturalization Service office at the port of departure. Summarize the departure circumstances by providing the following information:
Agent at Departure (Name & Address): Date of Departure: Port of Departure: Total Added Crew: Total Separated Crew:
Form I-418 (Rev. 03/07/2002)N
MASTER'S CERTIFICATION
MASTER: Execute the following oath before a Customs Officer as to all arriving passengers on all vessels, and to a Customs Officer and an Immigration Officer as to all departing crew on United States Flag Vessels, and before an Immigration Officer authorized to administer oaths as to all departing passengers on vessels. I certify that Customs baggage declaration requirements have been made known to incoming passengers, that any required Customs baggage declarations have been or will simultaneously herewith be filed as required by law and regulation with the proper Customs officer; and that the responsibilities devolving upon this vessel in connection therewith, if any, have been or will be discharged as required by law or regulation before the proper Customs officer. I further certify that there are no steerage passengers on board this vessel (46 U.S. C. 151-163).
Signature of Master:
CERTIFICATION OF COPY OF CREW LIST OF UNITED STATES FLAG VESSEL
I certify that this is a true copy of the original crew list of the named American vessel, which original crew list is on file in this office. Given under my hand and seal of office at the customhouse at on .
Signature of Customs Officer:
PASSENGER LIST Vessel Name: Family Name
X CREW LIST - Page
2 of
(CONTINUATION)
"ROGUE"
First Name & Initial Date of Birth
Arrival Port in U.S.: NEW ORLEANS Arrival Date: Nationality/ Document # Position or Title
(Crew Only)
12.09.03
Date Joined
(Crew Only)
Date Separated
(Crew Only)

UKRAINE KONONOV BRATUKHIN BAYGILDIN POPADYUK HUBRIY ZARVA KOBLYK POZHYDAYEV NITOCHKIN OMELCHENKO SERGIY SERGIY IGOR VITALIY YEVHEN IGOR MYKHAYLO YEVHEN OLEG ANATOLIY 09/27/62 RUSSIAN 01/17/65 UKRAINE 07/28/67 UKRAINE 01/16/83 UKRAINE 05/14/79 11/28/87 11/23/84 02/03/71 05/14/75 11/08/63 03/17/50 POLISH JANOWSKI CHEKOV TOMASZ ANATOLIY 10/10/68 UKRAINE 07/17/69 COOK 27.06.03 FITTER 03/20/07 UKRAINE AM100029 POLISH UKRAINE AT745080 UKRAINE AC792837 UKRAINE AC987876 UKRAINE O/S O/S OILER OILER OILER FITTER FITTER 03/15/07 27.06.03 03/15/07 03/15/07 27.06.03 03/16/07 03/20/07 A/B 03/15/07 A/B 05.08.03 A/B 03/15/07 BOSUN 08/07/07
SOBIESZCZANSKI ZBIGNIEV
CONTINUED
I-418 Receipt Number (INS Use Only)
Form I-418 (Rev. 03/07/2002)N
Signature of Master: CERTIFICATION OF COPY OF CREW LIST OF UNITED STATES FLAG VESSEL
I certify that this is a true copy of the original crew list of the named American vessel, which original crew list is on file in this office. Given under my hand and seal of office at the customhouse at on .
Signature of Customs Officer:
PASSENGER LIST Vessel Name: Family Name
X CREW LIST - Page Arrival Port in U.S.:
of
(CONTINUATION) Arrival Date:
"ROGUE"
Nationality/ Document # UKRAINE
Position or Title
(Crew Only)
Date Joined
(Crew Only)
Date Inspection Status Separated (INS Use Only)

(Crew Only)
TROYAN FESHCHUK KURMANOV BOGDANOV RUSEISHVILI KASYAN SARBEYEV ERMAKOV YURCHENKO ZANIN NAGORNYKH BILOUSOV GONCHARUK SURZHUK PINKOVSKY BAGRIY MISCHENKO ALUTIN BEREZAN IVANICHEK
SERGIY VOLODYMYR OLEKSANDR ANDREY TENGIZ IVAN OLEKSANDR ANDRIY SERGIY YEVGEN SERGIY OLEKSANDR RUSLAN DMYTRO VIKTOR VASYL YEVHEN YURIY ANATOLIY MYKHAYLO
26.12.51 23.03.51 02.06.67 26.08.78 20.09.46 20.01.50 08.07.62 04.07.62 01.01.72 22.08.68 26.10.63 16.03.66 06.08.71 04.10.71 26.01.77 23.06.70 29.11.61 03.12.58 05.05.56 03.08.56
AB186625
UKRAINE
MASTER CH/OFF 2ND/OFF 3RD/OFF CH/ENG 2ND/ENG 3RD/ENG 4TH/ENG ELECTR. BOS'UN A/B A/B A/B O/S O/S OILER OILER OILER FITTER CH/COOK
01.04.03 05.08.03 27.06.03 27.06.03 01.04.03 27.06.03 05.08.03 27.06.03 05.08.03 01.04.03 21.11.02 05.08.03 21.11.02 01.04.03 27.06.03 21.11.02 21.11.02 27.06.03 21.11.02 01.04.03
CONTINUED
AB137883
UKRAINE
AB148916
RUSSIA
MF0067625
GEORGIA
6765
UKRAINE
AB273366
UKRAINE
AB253181
UKRAINE
AB002675
UKRAINE
AB036220
UKRAINE
AB143488
UKRAINE
AB104292 UKRAINE AB162811 UKRAINE AB112729 UKRAINE AB123949 UKRAINE AB113997 UKRAINE AB102725 UKRAINE AB182632 UKRAINE AB144457 UKRAINE AB159760 UKRAINE AB070621
Form I-418 (Rev. 03/07/2002)N
U.S. Department of Justice Immigration and Naturalization Service

Prior to arrival in the United States, complete a separate form a) working crew; and b) passengers and supernumeraries. In addition to its initial completion,the crew list shall be updated to reflect crew changes and other relevant activity (or lack thereof) until the vessel
departs the United States.
Vessel Name:
"ROGUE"
12.09.2003
Nationality:
VALLETTA
Official Number:
6608/8021323
07.09.03 22 # of Passengers: NIL
Last foreign port (Place & Country): SANTA MARTA / COLOMBIA Date of Arrival in U.S.: Arrival Port: NEW ORLEANS
BLUE WATER SHIPPING COMPANY
Date sailed from foreign: # of Crew (including Master):
Agent at Arrival (Name & Address):
Will crew perform longshore work while vessel is in the United States? [ X ] NO [ ] YES
(Provide applicable INA Section 258 Exemption):
PROPOSED ITINERARY
Next U.S. Port(s) Arrival Date Vessel Agent (Name & Address)
PASSENGER LIST
CREW LIST - Page 1 of
List individuals alphabetically. Crew who join the vessel subsequent to its arrival while in the United States must be added to the original list and the appropriate date recorded in the 'Date Joined' column. The 'Date Separated' column must be used when a listed crewman is separated from the vessel while it is in the . Unated States.Any crewman designated as "REFUSED" in the 'Government Use Only' column is to be detained on the vessel at all times.
FamilyName
First Name & Initial
Date of Birth
Position or Title
(Crew Only)
Date Joined
(Crew Only)
Date Separated
(Crew Only)

VLASOV YERYOMENKO RYBCHUK STARODUB KORCHYNSKY SYZONENKO SAVCHUK LYSENKO BAKHIN
MYKHAYLO MYKOLA ANDRIY MYKHAYLO VIKTOR EDUARD VOLODYMYR VOLODYMYR VASYL
01/16/64 04/27/50 03/12/72 08/06/72 10/06/39 11/16/74 07/28/71 03/06/78 12/28/59
UKRAINE AB310289 UKRAINE AB285863 UKRAINE AB016776 UKRAINE AB315494 UKRAINE AB331888 UKRAINE AB276386 UKRAINE AB324698 UKRAINE AB181048 UKRAINE AB328721
MASTER CH.OFF. 2 OFF. 3 OFF CH.ENG. 2 ENG. 3 ENG. 4 ENG. ELECTR.
07/17/07 05.06.03 27.06.03 27.06.03 08/07/07 27.06.03 03/15/07 27.06.03 03/16/07

X CONTINUED
RECEIPT FOR CREW (INS Use Only). I-418 Receipt Number at right indicates that the Immigration and Naturalization Services has received the CREW LIST containing the names of all members of crew, including Master, on board said vessel at time of its arrival.
INS Port of Arrival (address):
SUMMARY OF DEPARTURE
Vessel Agent (at Departure): Following this vessel's departure from the United States, ensure that crew list reflects all crew additions and separations and is promptly submitted to the Immigration and Naturalization Service office at the port of departure. Summarize the departure circumstances by providing the following information:
Agent at Departure (Name & Address): Date of Departure: Port of Departure: Total Added Crew: Total Separated Crew:
Form I-418 (Rev. 03/07/2002)N
Form I-418 (Rev. 03/07/2002)N
Signature of Master:
CERTIFICATION OF COPY OF CREW LIST OF UNITED STATES FLAG VESSEL
I certify that this is a true copy of the original crew list of the named American vessel, which original crew list is on file in this office. Given under my hand and seal of office at the customhouse at on
Signature of Customs Officer: CREW LIST - Page 2 of
PASSENGER LIST Vessel Name:
(CONTINUATION) Arrival Date:
"ROGUE"
Arrival Port in U.S.: NEW ORLEANS Position or Title

(Crew Only)
12.09.2003
Family Name
Date Joined
(Crew Only)
Date Separated
(Crew Only)

KONONOV BRATUKHIN BAYGILDIN POPADYUK HUBRIY ZARVA KOBLYK POZHYDAYEV NITOCHKIN OMELCHENKO SOBIESZCZANSKI JANOWSKI CHEKOV
SERGIY SERGIY IGOR VITALIY YEVHEN IGOR MYKHAYLO YEVHEN OLEG ANATOLIY ZBIGNIEV TOMASZ ANATOLIY
09/27/62 01/17/65 07/28/67 01/16/83 05/14/79 11/28/87 11/23/84 02/03/71 05/14/75 11/08/63 03/17/50 10/10/68 07/17/69
UKRAINE AB284428 RUSSIAN AB278158 UKRAINE AB336432 UKRAINE AB072589 UKRAINE AB302133 UKRAINE AB356561 UKRAINE AB352937
UKRAINE
BOSUN A/B A/B A/B O/S O/S OILER OILER OILER FITTER FITTER FITTER COOK
08/07/07 03/15/07 03/15/07 03/15/07 03/15/07 27.06.03 03/15/07 03/15/07 27.06.03 03/16/07 03/20/07 03/20/07 27.06.03
AB292259
UKRAINE
AB139153
UKRAINE
AB159760 POLISH 227431 POLISH 210324 UKRAINE AB344619
CONTINUED
Form I-418 (Rev. 03/07/2002)N
INSTRUCTIONS
ALL NAMES AND OTHER DATA INSCRIBED ON THIS FORM MUST BE IN THE ENGLISH LANGUAGE. PASSENGERS: Deliver one complete alphabetical passenger list, regardless of nationality, to United States Public Health Service, United States Immigration Service, and two such lists to United States Customs Bureau on arrival at first port in the United States. CREW LIST VISA APPLICATION: Submit form in duplicate to U.S. consular officer, specifying each alien crewman not in possession of a valid individual visa or lawful resident alien card. ARRIVING CREW: Deliver one complete alphabetical crew list, regardless of nationality, to United States Public Health Service, United States Immigration Service, and two such lists to United States Customs Bureau on arrival at first port in the United States. Where a crewman is a returning resident, show his/her alien registration receipt number where promoted for a document number. CHANGES IN CREW: If an alien crewman is separating from the vessel while in the United States (and will not be returning), discharge authorization must first be obtained from the United States Immigration Service via Form I-408 (Application to Pay Off or Discharge Alien Crewman) and the appropriate date of separation must be recorded in the 'Date Separated' column of this form for that crew member. If a crew member joins the vessel while in the United States, add the crewman's name and other requested information at the next available blank line of the list and record the appropriate date in the 'Date Joined' column. DEPARTING CREW: When the vessel departs the United States, complete the SUMMARY OF DEPARTURE section and deliver one complete list (whether or not there have been crew changes) to the United States Immigration and Naturalization Service at the port of departure.
PAPERWORK REDUCTION ACT NOTICE.

We try to create forms and instructions that are accurate, can be easily understood and which impose the least possible burden on you to provide us with the information. Often this is difficult because some immigration laws are very complex. The average time to complete and process this form is one hour. If you have comments regarding the accuracy of this estimate or suggestions for making the form simpler, please write to the Immigration and Naturalization Service, HQPDI, 425 I Street, N.W. Room 4034, Washington, D.C. 20536; OMB No. 1115-0083. DO NOT MAIL YOUR COMPLETED FORM TO THIS ADDRESS.
Form I-418 (Rev. 03/07/2002)N
DEPARTMENT OF THE TREASURY

UNITED STATES CUSTOMS SERVICE
SHIP'S STORES DECLARATION
Arrival
1. Name of ship: 4..Nationality of ship: 6. Number of persons onboard
Departure NEW ORLEANS

3. Date of arrival/dep.
"ROGUE" VALLETTA NIL

7.Period of stay
2. Port of arrival/dep.
5. Port arrived from/Port of destination : 8. Place of storage
SANTA MARTA
Respective Store Rooms
9. Name of article DECK Ammunition, 38 cal. Revolver, 38 cal Rope, Fibre - other than moorings Rope, Wire- other than moorings
10. Quantity NIL NIL 16 PCS 1100 M
11. For official use
ENGINE Fuel Oil - Tons Metric Diesel Oil - Tons Metric Lubrication Oil - Tons Metric Fresh Potable Water - Tons Metric
276 66 18350 150
STEWARD Cereal & Pasta - inc rice + flour, etc. Coffee Dairy Eggs Fish - Frozen, fresh & Salt Fruit - Fresh, dried &canned Meat - Fresh, canned & salt Poultry Vegetables - Fresh, frozen, can & Dry Sugar Cooking Oil GENERAL Engine Room Chemicals Detergents & Soap Grease Kerosene & Solvents Paint and additives Deck Chemicals Rags BONDED Beer (cases) Cigarettes (cartons) Spirits - all types (bottles) Wines (bottles) Tobacco
15/100/200 KGS 7 KGS 30 KGS 360 PCS 80 KGS NIL 200 KGS 100 KGS 250 KGS 200 KGS 60 LTRS
510 KGS 50 KGS/150 PCS 180 KGS NIL 925 KGS 20 KGS 20 KGS
NIL 87 2 NIL NIL
NARCOTICS Gardenal(phenobarbital),tablets Diazepam Tablets, 5mg Diazepam ,ampuls 10mg
20 30 6
Also such broken and sundry stores as linen, crockery, silver, spare parts, tools, instrument hospital supplies and slop chest stores as required by law and/or necessary for the safe and efficient navigation of the vessel. Also all spares required under IMO and Bahamian Regulations for the safe operation of the vessel per spares inventories on board
12. Date and Signature by master, authorized agent or officer.
Mast er
O.GRITSENKO
CUSTOMS FORM 1303 (3-20-75)
Form Approved O.M.B. No.48-RO486
Page No.
1 of 1
12.09.03
er, spare parts, tools, instrument hospital supplies and slop chest stores
CUSTOMS FORM 1303 (3-20-75)
DEPARTMENT OF THE TREASURY

UNITED STATES CUSTOMS SERVICE
Form Approved O.M.B. No. 1515-0061
CREW'S EFFECTS DECLARATION

19 CFR 4.7(a). 4.7a(b) Page No.
1
1. Name of Ship
2.
Articles aquired abroad by officers and members of the crew (except those exclusively for use on voyage or cleared through Customs authorities
"ROGUE"
3. Nationality of Ship
VALLETTA
4. No.5. Family name, given names 6. Rank or rating Cigs.
Spirits
Beer
Other
7. No. of crewmember's declaration of articles intended to be landed (if none:show "None" opposite name)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
VLASOV MYKHAYLO YERYOMENKO MYKOLA RYBCHUK ANDRIY STARODUB MYKHAYLO KORCHYNSKY VIKTOR SYZONENKO EDUARD SAVCHUK VOLODYMYR LYSENKO VOLODYMYR BAKHIN VASYL KONONOV SERGIY BRATUKHIN SERGIY BAYGILDIN IGOR POPADYUK VITALIY HUBRIY YEVHEN ZARVA IGOR KOBLYK MYKHAYLO MISCHENKO YEVHEN NITOCHKIN OLEG OMELCHENKO ANATOLIY SOBIESZCZANSKI ZBIGNIEV JANOWSKI TOMASZ PARTASOV ANATOLIY KIRIN OLEKSIY CHEKOV OLEKSANDR
200 200 NIL 200 200 NIL 200 NIL NIL 140 200 200 200 200 200 200 NIL NIL 200 NIL 200 NIL NIL 200
NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL
NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL 1 NIL NIL NIL NIL NIL NIL NIL NIL NIL
PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL PERSONAL
none none none none none none none none none none none none none none none none none none none none none none none none
8. Date and sinature by master, authorised agent or officer.
O.GRITSENKO
This form may be printed by private parties (see 19 CFR 4.99) For Sale by District Directors of Customs.
CUSTOMS FORM 1304 (111888)
DEPARTMENT OF THE TREASURY UNITED STATES CUSTOMS SERVICE

VESSEL ENTRANCE OR CLEARANCE STATEMENT Trade Code (see back) Customs Directive No.3120-017 1. Manifest Number 2. Port of Arrival 3. Date & Time of Arrival/Departure
OMB No. 1515-0060
ENTRANCE
CLEARANCE
02
4. Vessel Operating Draft (in feet and inches)

(see back for instructions)
NEW ORLEANS
5. Nationality, Name and Type of Vessel
back for instructions) (see
12.09.2003
6. Vessel Built at/Year
9,3 m
7. Name Address & Phone No. of Ship's Agent
VALLETTA
DRY CARGO
"ROGUE"
Shin Kurushima Dockyard Co, Japan BLUE WATER SHIPPING COMPANY FAX 504-4558650 29578 504-8897409 504-5836077 504-3470424 504-5826192
9. Name & Country of Operator
(see back for instructions)
8. Name & Country of Owner
MARITEAM SERVICES INC. AOSTA SHIPPING Co.Ltd.

10. Gross Tonnage 11. Net Tonnage
6 RIZARIOU Str.HALANDRI,ATHENS,13233 GREECE

12. Port Arrived From/Departed For 13.IMO#/Official No./Call Sign(see back for instructions)
13432
14. List All Dock Locations
8232
(scontinue on back if necessary)
SANTA MARTA
6608/8021323
9HUF8
15. Particulars of Voyage. (Previous and Subsequent Ports off Call; underline where remaining cargo will be discharged)
(scontinue on back if necessary)
TUBARAO-PARANAGUA-ROSARIO-DJEN.DJEN-NUEVA PALMIRA-SANTA MARTA-NEW ORLEANS

16. Brief Description of Cargo 17. Check if incomplete Manifest for Export Check if Complete Manifest filed for 19. Number of Passengers Check if Licensed Cargo Loaded 20. List All Carriers on Board by SCAC Code export.
IN BALLAST
18. Number of Crew
22
21. Tonnage Mark
NIL
22.Bunkers; Type, Barrels, Value
None Submerged Not Submerged 23. Load Line Expires 24. Solas Certificate Expires
25. Passengers Allowed Per Coast Guard Certificate
26. Number of Passengers Embarking/Disembarking
1-Mar-05
27. Cert. Of Fin. Resp. No. (Oil Pollution) and Exp. Date.
NIL
NIL
28. Cert. Of Fin. Resp. (Passenger Death/Injury)
29. Cert. Of Fin. Resp. (Passenger Transportation Identification)
849018-03 14-Jan-06
NIL
X (Export Cargo on Board on Arrival) N (No Cargo Transportation)
NIL
L (Lade Cargo For Export) Y (Military Cargo For Discharge)
30. PURPOSE OF ENTRY OR CLEARANCE D (Discharge Foreign Cargo) F (Foreign Cargo to Remain On Board (FROB))
31. Print and Sign Name of Master, Authorised Agent or Officer, Date.
O.GRITSENKO
FOR CUSTOMS USE ONLY

32. Customs Fee Paid Up* 35. Cash Receipt, CF 368 or Transaction No. 33. APHIS User Fee Paid Up* 36. Total Fees Collected 34. Tonnage Tax Paid UP* 37. Port Entered/Cleared, Time and Date
38. Customs Officer Remarks
39. Signature and Title of Officer Receiving Entry/Granting Clearance
CHECK BOXES ONLY IF FEES NOT COLLECTED
Customs Form 1300 (0100)
INSTRUCTIONS
Trade Codes: Please enter the code that best describes the arriving or departing vessel. (1) (2) (3) (4) (5) (6) Foreign in Ballast Foreign Bulk Foreign General Cargo Domestic or Coastwise Ballast Domestic or Coastwise Bulk Domestic or Coastwise General Cargo
Block 4 - Vessel Operating Draft: (not the design draft) Deepest draft of the vessel on entrance (in feet and inches) Deepest draft of the vessel on clearance (in feet and inches) Block 5 - Vessel Types: List one of the codes and descriptions from below 111 112 140 150 210 229 310 325 330 333 340 341 Crude Oil Tanker Crude/Products Tanker Tank Barge Other Tanker Bulk/Oil Carier Bulk Carrier Container Vehicle Carrier General Cargo RO-RO Cargo Dry Cargo Barge Deck Barge 350 410 421 422 431 432 492 493 494 499 600 Passenger Fish Processing & Catching Drilling Ship Tug/Supply Offshore Support Tug/Tow boat Pushboat Research/Survey Dredger Yacht Other NEI Lakers Vessels
Block 9 - Operator as listed on the Certificate of Financial Responsibility (Oil Pollution); unless other verifiable charter or lease arrangement indicates otherwise.
Block 13 - If IMO # is available list that and cross out other two titles. If IMO # not available list either or both the Official number and/or Call Sign and cross out the IMO #.
Block 14 -- Additional information
Block 15 -- Additional Information
PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act of 1995. The information to be provided is submitted by the Master of the vessel and is used by Customs to attest to the truthfulness of the forms, certificates, and manifest on board and which must be present to Customs. Completion of this form is mandatory. It is also used by Customs to verify the various registration certificates and numbers. The estimated average burden associated with this collection of information is 5 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimates and suggestions for reducing this burden should be directed to U.S. Customs Service, Reports Clearance Officer, Information Services Branch, Washington D.C. 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1505-0060), Washington D.C. 20503. U.S. GPO: 2000-511-342 Customs Form 1300 (01/00)

CREW7

Enviado por

Dados do documento

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

CREW7

Enviado por

Direitos autorais:

Formatos disponíveis

UK P&I Club

FIRST NAME & INITIAL

Durban Sankt Peterburg 9/9/2007

United States Coast Guard

SEAMAN BOOK NO. JOINED DATE PLACE JOINED US VISA EXPIRY

UKRAINE UKRAINE UKRAINE

VISA TYPE YELLOW FEVER EXPIRY

21.Jul-09 10-Apr-13 08-Feb-16

"ROGUE" VALLETTA 8 O.GRITSENKO 6608/8021323 22 9HUF8 13432 8232

AOSTA SHIPPING Co.Ltd. MARITEAM SERVICES INC.

6 RIZARIOU Str.HALANDRI,ATHENS,13233 GREECE

PORTS of CALL LIST

Port of registry :VALLETTA, MALTA

LIST PORT OF COLL PORTS OF CALL LIST

Master of the m/v " ROGUE "___________________________ VLASOV MYKHAYLO

IMO CREW'S EFFECTS DECLARATION

Date and signature by Master, authorized agent or officer

Port of PORT: Arrival/Departure :

IMO CREW'S EFFECTS DECLARATION

Date and signature by Master, authorized agent or officer

TELEPHONE CARDS LIST

Date and signature by Master, authorized agent or officer

LIST OF CREWS ADVANCE

Date and signature by Master, authorized agent or officer

CREW'S CURRENCY DECLARATION

4.No 5.Family name,given name

263 Grv of Ukraine

NIL NIL NIL NIL NIL NIL NIL NIL NIL

NIL NIL NIL NIL

Date and signature by Master, authorized agent or officer

Port of Arrival/Departure : 9/9/2007

IMO CREW'S EFFECTS DECLARATION

4.No 5.Family name,given name

7.Personal effects Clothing and Personal Effects

MASTER CH.OFF. 2 OFF.

Clothing and Personal Effects 200 1 1 1 1 NIL NIL 1 NIL NIL

Clothing and Personal Effects

Clothing and Personal Effects

Clothing and Personal Effects

Clothing and Personal Effects

2 ENG. 3 ENG. 4 ENG. ELECTR. BOSUN

Clothing and Personal Effects

Clothing and Personal Effects

A/B A/B A/B O/S O/S

Clothing and Personal Effects

Clothing and Personal Effects

OILER OILER OILER FITTER FITTER FITTER COOK M/M M/M

Date and signature by Master, authorized agent or officer

Port of Arrival/Departure : 9/9/2007

MARITEAM SERVICES INC.

12. Date and signature by Master, authorised Agent or Officer.

Master of m/v "Rogue"

Page:1/1 File no.:VS-D-19 File / HO-CR-02 no: C-1

SHIP'S STORES DECLARATION

4..Nationality of ship: 6. Number of persons onboard

RESPECTIVE STORE ROOMS

10. Quantity NIL NIL 2350 686 3700 4100

11. For official use

12 pcs 12 pcs 2 pcs 4 pcs 8 pcs 12 pcs 4 pcs

12. Date and signature by Master, authorised Agent or Officer.

Master of the m/v "ROGUE "

Maritime Declaration of Health

Date: From : Durban

9/9/2007 To: Sankt Peterburg