[A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link. ]
Must be submitted 96 hours prior to arrival with crew list and passenger list.
Please submit by fax or e-mail.
- Telephone Number:
- (855) 682-1262
- (855) 682-1262
- Fax Number
- (613) 960-1556
- 1 Vessel Name
- 2 Registration/IMO Number
- 3 Port of Registry
- 4 Call Sign
- 5 Country of Registry
- 6 Gross registered tons
- 7 Net registered tons
- 8 Port of Arrival
- 9 Date and Time of Arrival (YYYY/MM/DD – HH:MM)
- 10 Dock Number
- 11 Anchorage Sector
- 12 Date and Time of Departure (YYYY/MM/DD – HH:MM)
- 13 Brief Description of Cargo
- 14 Number of Containers
- 15 Reason for Call
- Seaway Inspection
- 16 Vessel Type
- General Cargo
- 17 Type of Service
- 18 If liner
- Conference line
- Independent line
- 19 Charterer
- 20 Owner
- 21 Last Dry Dock (Port and Date)(YYYY/MM/DD)
- 22 Recent or Foreign Repairs
- 23 Itinerary (last 5 ports of call starting with the most recent)
- 24 Nationality of Crew
- Number of Crew
- 25 Next Port of Call
- Number of Crew/Passengers Signing Off/On
- Indicate Numbers From Crew List
- Number of Passengers/Stowaways
- 26 Is this vessel carrying cash or monetary instruments valued at greater than $10 000.00 Canadian in the care of the Captain or any individual on board?
- 27 Will the vessel discharge International Waste?
- 28 Is the vessel carrying ships stores?
- 29 Certificates (Indicate expiry date)
- 30 Safety Construction (YYYY/MM/DD)
- 31 Sanitation (YYYY/MM/DD)
- 32 Loadline (YYYY/MM/DD)
- 33 Safety Equipment (YYYY/MM/DD)
- 34 Safety Radio (YYYY/MM/DD)
- 35 IOPP (YYYY/MM/DD)
- 36 Shipping Agent
- 37 Contact Name
- 38 E-Mail
- 39 Telephone Number
- 40 Fax Number
- 41 Cellular Number
- 42 Comments
1 Vessel Name
Record the registered name of the vessel
13 Brief Description of Cargo
Indicate whether the vessel will arrive or depart in ballast or carrying cargo. For cargo carrying vessels provide a brief description of the type of load. If the cargo is in transit (neither loaded nor unloaded at the port), write “Cargo in Transit” and the cargo tonnage in this field.
14 Number of Containers - Other
For other than 20' or 40' containers specify the actual container size in addition to recording the number carried.
17 Type of Service
Report the type of service by which the vessel is operating based on the following definitions:
- Liner: ship on a regularly scheduled service; includes conference line and independent (non-conference) service.
- Other: such as tramp, oil tanker, product carrier, dry bulk.
18 If Liner
Indicate type of liner if applicable.
- Conference Line: Ship on a regularly scheduled service provided by shipping lines which are grouped together in an association operating exclusively on a prescribed route(s) between countries.
- Independent line: ship on a regularly scheduled services operated by a shipping line which is not associated with other lines on a prescribed route(s) between countries.
22 Recent or Foreign Repairs
Indicate type of repair conducted if applicable.
24 Nationality and Number of Crew
Indicate the number of crew for each nationality listed.
Indicate Numbers from Crew List
Indicate the position number from FAL Form 5/6 of crew member(s)/passenger(s) signing off/on vessel.
The information provided within this document and the International Maritime Organization (IMO) FAL form 5/6 is collected under the authority of the Reporting of Imported Goods Regulations pursuant to Section 12.1 of the Customs Act for the purposes of conducting risk assessments, recording the passage at the border and acting upon the recommendations resulting from the risk assessment process. Pursuant to Section 107(1) of the Customs Act, the information provided may be disclosed to other government organizations, as well as U.S. Customs and Border Protection.
Individuals have the right to access and/or can make corrections of their personal information under the Privacy Act. Information collected is described under the eManifest Personal Information Bank CBSA PPU 048 which is detailed at www.infosource.gc.ca.
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