THE PERFORMER MUST AT ALL TIMES BE IN POSSESSION OF THIS DOCUMENT
Loading/unloading of very toxic gases
exceeding a net weight of 100 kg
HKD 23
062014
Who should complete this form?
The company asking for permission to load/unload very toxic gases exceeding a net weight of 100 kg, as set out
in the Municipal Port Police Regulations, chapter 4.
To whom should the form be sent?
Requests must be sent by e-mail to the chief dockmaster no later than 2 hours before the effective handling:
Chief dockmaster: DWW_SVM@portofantwerp.com
In addition, this notification must be sent to the Fire Service for information purposes.
Fire Service Right Bank: head watch office Lillo, Scheldt quays, tel +32–3-561 03 50 / fax +32-3-561 03 53
Fire Service Left Bank: Gravendreef 5, 9120 Beveren, tel +32-3-750 14 50 / fax +32-3-755 27 78
PRINCIPAL’S DETAILS
1
Please enter below the principal’s details.
Company name
Address
Phone
Fax
E-mail address
Capacity:
forwarder
shipping agent
both
CONTACT DETAILS
2 Please enter the contact details below.
Name
Phone
E-mail
1/2
First issue date:
Revision date:
Drawn up by:
01/2014
Document:
Reference:
Page:
Manager:
HKD23
HKD/GM
THE PERFORMER MUST AT ALL TIMES BE IN POSSESSION OF THIS DOCUMENT
SPECIFICATIONS OF THE GOODS
3
Please enter the specifications of the product to be loaded/unloaded below.
.
Quantity &
IMDG
Technical name
Container number
VR No.
type
class
Net weight (in
kg)
HANDLING DETAILS (MANDATORY)
Loading
Unloading
Incoming
Outgoing
Seagoing ship
Barge (name):
Quay number:
Date and time:
2/2
First issue date:
Revision date:
Drawn up by:
01/2014
Document:
Reference:
Page:
Manager:
HKD23
HKD/GM