ICS Ballast Water Management System Feedback Form

1. Section A : General Information

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* 1. IMO number of ship affected by identified issue. (Details will remain confidential and only be used internally by the ICS Secretariat)

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* 2. Ship's date of delivery.

Date

Date

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* 3. Ship type.

Tanker

Bulk carrier

Passenger

Special purpose

General cargo

Container

Other (please specify)

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* 4. Ship Size (choose appropriate measure)

Deadweight (DWT)

Gross Tonnage (GT)

Container capacity (TEU)

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* 5. Ship operator (Details will remain confidential and only be used internally by the ICS Secretariat)

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* 6. Company contact person (Provide contact details in case for follow up)