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IMO Crew List

Page number
Arrival Departure

1.1 Name and type of ship 2. Port of arrival/departure 3. Date of arrival/departure


1.2 IMO number
1.3 Call sign
4. Flag state of ship 5. Last port of call 6. Nature and
number of identity
document
(seaman’s passport)

7. Number 8. Family name, given names 9. Rank 10. Nationality 11. Date and place
or rating of birth

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

Signed Date / /

IMO FAL
Form 5
C97 HMRC 10/06

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