出入境船舶卫生检疫查验所需表格

中华人民共和国出入境检验检疫

Entry-Exit Inspection and Quarantine of the P.R.C.

国际航行船舶入境检疫申报书

Entry Quarantine Declaration for International Voyages 本申报书由代理或船方在入境前申报编号No

附录C 入境船舶检疫申报书

QUARANTINE DECLARATION FOR ARRIV AL

────────────────────────────────────────船名（航次）Name of Ship 国籍Nationality

本港是否采购食品？Will any food be taken at this port？否NO □；是YES □.

本港是否采购饮用水？Will any fresh water be taken at this port？否NO □；是YES □.

如果有，请填写《船舶购置食品、饮用水报告单》。If yes，please fill the “FOOD AND WATER FROM LOCAL SUPPLIER”.

2.本港是否有船员离船Will any crew sign off at this port？否NO □；是YES □.

有船员离船，是否携带以下特殊物品？If yes，anything below will be taken from the ship？

动物产品Animal products □动物尸体标本Animal carcasses and specimen □

土壤Soil □血液或血液制品Blood or blood products □

生物产品Biological products □

3.伴侣动物Pets/Birds：无NO □；有YES □.

如果有，请填写下表。If yes，please fill the form below.

4.本港是否有船舶废弃物移下？Will any vessel waste be discharged at this port？否NO □；是YES □.

5.垫舱物料dunnage：无NO □；有YES □.

船长签名/Signature and stamp 日期/Date

AN APPLICATION FOR DISCHARGING BALLAST WATER

1 、本申请书与《压舱水申报单》一并使用。

Used together with “Ballast Water Reporting Form”.

2、本表一式两份，经批准后，一份交船方，另一份由检验检疫机构存查。

The application is in duplicate, after approval one sent on board the ship and the other filed by the . Inspection and Quarantine Authorities.

3、船舶排放压舱水一旦发生污染等情况，应立即向检验检疫机构报告并接受调查处理。

In case of marine pollution, a report shall be made immediately to Inspection and Quarantine Authorities and the ship shall be prepared for investigation and settlement.

本表用于申报本港购买食品、饮水之用，如未购买，请填写“无”：

For provisions purchased from local supplier. Fill NIL if there’s on purchase.

船舶购置食品、饮用水报告单

FOOD AND WATER FROM LOCAL SUPPLIER 船名Name of ship

船长签字日期

Signature of master . Date

附：船方收到的购货发票或复印件

Note: A copy of invoice shall be presented