船舶保安申明
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保安声明
DECLARATION OF SECURITY
船名：
Name of ship:
登记港：
port of registry:
IMO编号:
IMO Number:
港口设施名称：
Name of Port Facility:
本《保安声明》的有效期自至涉及下列活动：
This declaration of security is valid from until , for the following activities .
（活动清单，包括细节）
(list the activities with relevant details)
所处保安等级：
under the following security levels
船舶保安等级：
security level(s) for the ship:
港口设施保安等级：
security level(s) for the port facility: 港口设施和船舶同意以下保安措施和责任，以确保符合《国际船舶和港口设施保安规则》A部分的要求。
The port facility and ship agree to the following security measures and responsibilities to ensure compliance with the requirements of Part A of the International Code for the Security of Ships and of
本协议的签字人证明在具体活动中港口设施和船舶的保安措施和安排符合第XI-2章和本规则A 部份的规定，并将根据其经批准计划的规定或所同意的列于附件中的具体安排来实施。
The signatories to this agreement certify that security measures and arrangements for both the port facility and the ship during the specified activities meet the provisions of chapter XI-2 and Part A of Code that will be implemented in accordance with the provisions already stipulated in their approved plan or the specific arrangements agreed to and set out in the attaches annex.
签署日期
地点
（港口设施保安员签名）（船长或船舶保安员签名）
港口设施船长
Port Facility Master
港口设施保安员船舶保安员
Port Facility Security Officer Ship Security Officer
公司
Company
公司保安员
Company Security Officer