| Signed for and on behalf of |
| Mother vessels
(Signature of master or ship security officer) |
Daughter vessel
(Signature of master or ship security officer) |
| Contact details
(to be completed as appropriate) |
(Indicate the telephone numbers or the radio channels or frequencies to be used)
| For mother vessel | For daughter vessel |
Daughter vessel Mother vessel
Master::
Ship security officer:
Company:
Company security officer:
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