Form

IMO
FAL
IMO SHIP'S STORES DECLARATION

3
Page No.
     
Arrival Departure
1. Name of ship 2. Port of arrival/departure 3. Date of arrival/departure
m/v VIKKI            
4. Nationality of ship 5. Port arrived from/Port of destination
MALTA VALLETTA NOVOROSSIYSK

6. Number of persons on board 7. Period of stay 8. Place of storage

20 UNKNOWN GENERAL

9. Name of article: GENERAL 10. Quantity 11. For official use

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PRINTER HP 2 PCS      

PRINTER EPSON 1 PCS      

XEROX CANON 1 PCS      

XEROX SAMSUNG 1 PCS      

TV SET 4 PCS      

DVD PLAYER 3 PCS      

IMO Convention on Facilitation of International Maritime Traffic

VIDEO PLAYER 2 PCS      

WASHING MASHINE 3 PCS      

REFRIGERATOR 8 PCS      

FREEZING CHAMBER 6 PCS      

FOTOCAMERA FUJI 1 PCS      

COMPUTER 3 PCS      

AIR CONDITION 2 PCS      

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

12. Date and signature by master, authorized agent or officer