Placement of Privately Contracted Armed Security Personnel (PCASP) on board Maltese ships in accordance to Merchant Shipping Notice 106 Merchant Shipping Directorate Malta Transport Centre Marsa, MRS 1917 Malta Tel: +356 2125 0360 Fax: +356 2124 1460 Email: comms.isps@transport.gov.mt, www.transport.gov.mt/ship-registration/ Name of ship Overall length (meters) Gross Tonnage Interested Parties Operating Speed (knots) IMO number Call Sign 9H Description Cargo Incorporated Company Number Freeboard to the lowest deck (meters) Name Registered Owners ISM Company Charterer Other / Remarks Contact details Master Ship Security Officer Company Security Officer Private Maritime Security Company Incorporated Contact details PMSC Responsible person Privately Contracted Armed Security Personnel: Name Nationality Embarkation date Embarkation point / port Disembarkation date Disembarkation point / port Firearms: Firearm Serial no. Company No. Caliber Passport Number Ammunition Type Loading date Loading point / port Unloading date Unloading point / port Ammunition Qty. The undersigned declares that the details contained herein are correct and that the provisions of the Merchant Shipping Notice 106 have been complied with. ______________________ Company Security Officer Name: Date: Form: TM MSD PCASP 001 Registrar General of Shipping and Seamen Transport Malta is the Authority for Transport in Malta set up by ACT XV of 2009 Page 1 of 1