Name and description of ship Arrival Name and address of ship s agent

M/V MAX Departure DALEEL SHIPPING AGENCY CO.

Nationality of ship Port of arrival / departure
LIBERIA MISURATA / LIBYA
Name of master Port arrived from / Port of destınatıon Net Tonnage
MYKOLA SOSNOVSKY SALERNO / ITALY 3553
Port of registry Date - time of arrival / departure Number of Crew 11
MONROVIA 13.09.22 Call sign D5Z02
Gross tonnage
7532 Cargo CONTAINER N.O.R:

Rank or SEAMAN PERSONEL CURRENCY

No Family Name, Given Names
Rating
NATIONALITY Date of birth place of birth
BOOK NO
PASS. NO SPIRIT
EFFECT DECLARATION
COVID 19 YELOW FEVER DATE OF JOING

1 MYKOLA SOSNOVSKY MASTER UKRAINE 13.06.1982 ODESSA AB647781 FB469141 NIL 1 GSM , 1 HDD , 1 USB , 1 SPEAKER, 1 LAPTOP, P.E
NIL 13.01.2022 07.08.2015 21.01.22
2 OLEKSIY SHEVCHENKO CHF.OFF. UKRAINE 30.07.1969 KAZAKHSTAN AB6216673 FT131492 NIL 2 MOBILE 1 CAMERA 1 SILVER CHAIN 1 COLD RING 2 USB 1 TOUCHLIGHT, P,E,

NIL 23.09.2021 09.01.2009 17.07.22

3 GEORGII SELIVERSTOV 2ND OFF. UKRAINE 29.08.1990 KHERSON AB664973 FJ958059 NIL 1 MACKBOOK, 1 TABLET. 2 MOBILE. 1 EBOOK, 1 HDD, 3 WATCH, 3 USB, GOLD RING, GOLD NECKLESS, 2SILVER RING, 1 EYRPODS P.E.

NIL 05.10.2021 19.01.2009 30.01.22

4 ANDREI SHEVCHENKO CHF. ENG. RUSSIA 14.08.1971 USSR MK0007403 726845699 NIL 1 LAPTOP 1 MOBELE 1 HDD 2 GOLDRING 1 SUNGLASSES SILVER CHAIN AND CROSS

NIL 01.06.2022 18.10.2007 23.08.22

5 VSEVOLOD IUDEEV 2ND ENG RUSSIA 29.04.1995 PITKARANTA MK0213260 656812358 NIL 1 LAPTOP 1 HDD 1 MOBILE P E
NIL 27.05.2022 12.12.2015 04.07.22
6 ANTHONY MARK FLORIDA TOBIAS AB 2 PHILIPPINES 19.10.1983 PIGCAWAYAN C1031938 P5715551B NIL 2 MOBILE 1 WATCH 1 SPEAKER 1 HAIER CLIPPRE P,E
NIL 09.09.2021 09.09.2009 30.01.22
7 ELTON GILBUENA BATIANCILA AB 1 PHILIPPINES 09.11.1970 CEBU CITY C1110643 P5251045B NIL 1 LAPTOP 3 MOBILE 1 HDD 1 POWERBANK 1 USB 1 CAMERA 1 WATCH 1 HAIRCLIPPER P.E

NIL 23.11.2021 05.01.2011 21.01.22

8 LEMUEL ACOBA MARCAIDA OS 1 PHILIPPINES 09.03.1998 MANILA C1121668 P7616752B NIL 2 MOBILE 1 WATCH P.E NIL 13.01.2022 25.10.2021 21.01.22
JOHN9 DAVID DEL ROSARIO TORRES OS2 PHILIPPINES 25.03.1989 CALATAGAN BTS C1098314 P8136181B NIL 1 LAPTOP 1 MOBILE 1 WATCH 1 HEADSET 2 GOLD NEKLESS 1GOLD RING 1 HDD 1 POWERBANK P.E

NIL 23.12.2021 27.04.2011 30.01.22

10 CHRAYSDENTH EBENEZER PRADO OILER PHILIPPINES 20.10.1995 BACALOD CITY C1445379 P0840007B NIL 1 LAPTOP 1 MOBILE 1 HDD 4 USB 1 POWERBANK 1 WATCH 1 SPEAKER P.E

NIL 21.01.2022 28.04.2016 30.01.22

11 JOHN PAUL SUSVILLA COOK PHILIPPINES 02.06.1992 BACALOD CITY C0961893 P7980313B NIL 2 MOBILE 1 HEADSET 1 HDD P.E
NIL 13.10.2021 22.04.2014 30.01.22

LAST 10 PORT OF CALL TURKEY MERSIN MERSIN / TURKEY TR MER

PORT COUNTRY UNCTAD LOCODE ARR.DATE DEP DATE S.LEVEL TURKEY ALIAGA ALIAGA / TURKEY TR ALI AKKON LINES
1 SALERNO ITALY ITSAL 11.09.22 11.09.22 LEVEL 1 TURKEY GEMLİK GEMLİK / TURKEY TR GEM AKKON LINES
2 GENOVA ITALY ITGOA 09.09.22 10.09.22 LEVEL 1 TURKEY AMBARLI AMBARLI / TURKEY TR AMB AKKON LINES
3 BARCELONA SPAIN ESBCN 07.09.22 08.09.22 LEVEL 1 LIBYA MISURATA MISURATA / LIBYA LY MRA DALEEL SHIPPING AGENCY CO.
4 CASTELLON SPAIN ESCAS 06.09.22 07.09.22 LEVEL 1 LIBYA AL KHUMS AL KHUMS / LIBYA LY KHO DALEEL SHIPPING AGENCY CO.

5 VALENCIA SPAIN ESVLC 05.09.22 06.09.22 LEVEL 1 LIBYA TRIPOLI TRIPOLI / LIBYA LY TRI DALEEL SHIPPING AGENCY CO.

6 ORAN ALGERIA DZORN 03.09.22 05.09.22 LEVEL 1 TURKEY EVYAP EVYAP / TURKEY TR EYP AKKON LINES
7 ALGER ALGERIA DZALG 01.09.22 03.09.22 LEVEL 2 ALGERIA ANNABA ANNABA/ALGERIA DZAAE AKKON LINES
8 ANNABA ALGERIA DZAAE 31.08.22 31.08.22 LEVEL 1 TUNISIA SOUSSE SOUSSE / TUNISIA TN SUS SEAWAVE
9 GEBZE TURKEY TRGEB 26.08.22 27.08.22 LEVEL 1 ALGERIA ALGER ALGIER / ALGERIA DZ ALG CONTAINERSHIPS ALGERIA SARL

10 AMBARLI TURKEY TRAMB 25.08.22 26.08.22 LEVEL 1 TUNUS BIZERTE BIZERTE / TUNISIA TNBIZ AKKON LINES
GREECE PIRAEUS PIRAEUS / GREECE GR PIR COSCO SHIPPING

SPAIN BARCELONA BARCELONA / SPAIN ESBCN

SPAIN CASTELLON CASTELLON / SPAIN ESCAS
SPAIN VALENCIA VALENCIA / SPAIN ESVLC
" ITALY SALERNO SALERNO / ITALY ITSAL
ITALY GENOVA GENOVA / ITALY ITGOA
UKRAINE PIVDENNYI PIVDENNYI / UKRAINE UAYUZ
ALGERIA ORAN ORAN/ALGERIA DZORN
ROMANIA CONSTANTA CONSTANTA/ROMANIA ROCND
RUSSIA NOVOROSSISK RUSSIA RUNVS
 HIZMET BELGESI ICIN
SEAMANS
PASPORT
PLACE OF JOING GMDSS LICENCE BOOK EXP.
EXP DATE
DATE

MERSIN 12869/2015/11 1/2/2024 5/8/2025

VALENCIA 11053/2016/06 16.05.23 05.11.28
MERSIN 14687/2015/07 05.08.25 13.11.27
ALIAGA UNLIMITED 25.11.2023
AMBARLI UNLIMITED 25.02.2024
EVYAP 03.06.27 03.11.30
MERSIN 25.10.27 22.06.30
MERSIN 07.08.27 15.07.31
EVYAP 18.07.27 09.11.31
EVYAP 02.12.29 27.02.29
EVYAP 20.02.27 24.10.31
 HAZIRLANMASI GEREKEN LİMAN EVRAKLARI
MİSURATA
1 CREW BODY / 1 VAC LIST / 1 HEALTH/-3 CREW LIST / 3 STORE LİST / 3 NIL LİST / 1 CREW CURRENCY AGENT DEPARTURE NIL
& 2 EFFECT / 3 LAST TEN PORT / 3 SHIP CASH / 3 NARCOTIC LIST / 2 TONNAGE CERT / 2 PRINT ALL FAL FORM 2 COPY EACH
REGISTRY CERT

BIZERTE agent IMMIGRATION

-3 CREW LIST / 2 STORE LİST / 1 NIL LİST / 2 CREW EFFECT / 1 SHIP CASH / 2 NARCOTIC LIST / 2 CREW LIST/ 1 NIL LIST/ 1 PORT OF departure
2 LAST TEN PORT / 1 M.HEALT DECLARATION / 1 MEDICINE LIST / 1 SHIP PART / 1 CARGO MAN / CALL / 1 SHIP PART / 1 NARCOTIC / 1 1 crew list. 1 nil list. 1 narcotic
2 DG CARGO CARGO MAN / 1 DG CARGO

CUSTOM 1 immigration 1 COAST GUARD

ALGER agent HEALTH:
CREW LIST / 1 STORE LIST / 1 SHIP
1 CREW LIST / 1 STORE LİST / 1 NIL LİST / 1 CREW CURRENCY & EFFECT / 1 LAST TEN PORT / 1 CREW LIST / 1 PORT OF CALL / 1
MONEY / 1 NARCOTIC / 1 PORT OF crew list / 1 PORT OF CALL / 1 nil list / 1 crew list 1 nil 1 POC 1 ship particular 1 store 1
1 SHIP CASH / 1 NARCOTIC LIST / 1 M.HEALT DECLARATION CREW TEMP / 1 HEALTH DEC 1 vac list 1 ship part / free partique / cargo maniferst FAL 2
CALL / 1 SHIP PART / 1 FREE PRACTIC

ANNABA AGENT
-10 CREW LIST /6 STORE LİST / 5 NIL LİST / 3 CREW CURRENCY / 3 CREW EFFECT / 3 SHIP CASH 2 CARGO MANIFECT 2 SHIP PART 2 NIL
5 cargo manifest
5 LAST TEN PORT / 4 NARCOTIC LIST / 2 M.HEALT DECLARATION / 4 MEDICINE LIST / 1 BODY TEMP / 1 LIST 2 CREW LIST 2 SHIP MONEY 2
VAC LIST / 1 yellow fever CREW EFFECT 2 STORE 2 POC

ARRIVAL DEPARTURE
GEMLIK 4 CREW LIST / 4 PORT OF CALL / 1 4 CREW LIST / 1
STORE STORE

ARRIVAL DEPARTURE
GEBZE / EVYAP 5 CREW LIST / 2 PORT OF CALL / 1 3 CREW LIST / 1
STORE STORE

CUSTOM 1 immigration 1 COAST GUARD

ORAN agent HEALTH:
CREW LIST / 1 STORE LIST / 1 SHIP
1 CREW LIST / 1 STORE LİST / 1 NIL LİST / 1 CREW CURRENCY & EFFECT / 1 LAST TEN PORT / 1 CREW LIST / 1 PORT OF CALL / 1
MONEY / 1 NARCOTIC / 1 PORT OF crew list / 1 PORT OF CALL / 1 nil list / 1 crew list 1 nil 1 POC 1 ship particular 1 store 1
1 SHIP CASH / 1 NARCOTIC LIST / 1 M.HEALT DECLARATION CREW TEMP / 1 HEALTH DEC 1 vac list 1 ship part / free partique / cargo maniferst FAL 2
CALL / 1 SHIP PART / 1 FREE PRACTIC
DEPARTURE DOC:
ARRIVAL DOC:
AMBARLI 4-crew list 1-store list 1-port of call
4-crew list 1-store list SP-1& DG cargo
by email departure info by email

ARRIVAL DOC:
DEPARTURE DOC:
VALENCIA 1-crew list 1-crew effect 1-nil list 1
nil
HEALTH DEC 1 STORE 1 POC

ARRIVAL TO BE READY AT GANGWAY :

1 STORE LIST / 1 PORT OF CALL / 1 NIL LIST /
BARCELONA 1 MARITIME DEC / 1 ISPS DEC / 1 CUSTOM
DEPARTURE NIL
CLERANCE (SEE PRE FOLDER BARCA)

castellon ARRIVAL NIL DEPARTURE NIL

ARR DOC
GENOVA 5 CREW LIST / 3 PORT OF CALL / 3 NIL
LIST / 3 CREW EFFECT / 3 STORE LIST
DEPARTURE NIL

ARR DOC
SALERNO 5 CREW LIST / 3 PORT OF CALL / 3 NIL
LIST / 3 CREW EFFECT / 3 STORE LIST
DEPARTURE NIL

ARR DOC
7 CREW LIST / 2 STORE LIST / 1 DEPARTURE
CREW TEMP / 3 PORT OF CALL / 2 CREW 7 CREW LIST / 2 STORE LIST
EFFECT / 1 TONAGE CERT / 1 SP1 BY EMAIL
aliaga SANITATION CERT
 CREW LIST
Arrival Departure
x

1. Name of Ship / Callsign 2.GRT / NRT 3.Port of Arrival / Departure 4.Date of arrival / departure

MV MAX / D5ZO2 7532 / 3553 MISURATA / LIBYA 13.09.22

5.Port of registry / nationality of ship: 6.IMO Number 7. Port country arrived from / destination 8. Number of persons on board

MONROVIA / LIBERIA 9351098 SALERNO / ITALY 11

Number of Seaman's Book

Date of Joining Seaman's Book Expire Dates GMDSS
No Given Name, Family Name Sex Rank Nationality Place of Birth Date of Birth Certificates ID
Number of Passport Expire Number
Place of Joining Passport Dates
21.01.22 AB647781 1/2/2024
1 MYKOLA SOSNOVSKY MALE MASTER UKRAINE ODESSA 13.06.1982 12869/2015/11 0
MERSIN FB469141 5/8/2025
17.07.22 AB6216673 16.05.23
2 OLEKSIY SHEVCHENKO MALE CHF.OFF. UKRAINE KAZAKHSTAN 30.07.1969 11053/2016/06
VALENCIA FT131492 05.11.28
30.01.22 AB664973 05.08.25
3 GEORGII SELIVERSTOV MALE 2ND OFF. UKRAINE KHERSON 29.08.1990 14687/2015/07
MERSIN FJ958059 13.11.27
23.08.22 MK0007403 UNLIMITED
4 ANDREI SHEVCHENKO MALE CHF. ENG. RUSSIA USSR 14.08.1971
ALIAGA 726845699 25.11.2023
04.07.22 MK0213260 UNLIMITED
5 VSEVOLOD IUDEEV MALE 2ND ENG RUSSIA PITKARANTA 29.04.1995
AMBARLI 656812358 25.02.2024
30.01.22 C1031938 03.06.27
6 ANTHONY MARK FLORIDA TOBIAS MALE AB2 PHILIPPINES PIGCAWAYAN 19.10.1983
EVYAP P5715551B 03.11.30
21.01.22 C1110643 25.10.27
7 ELTON GILBUENA BATIANCILA MALE AB 1 PHILIPPINES CEBU CITY 09.11.1970
MERSIN P5251045B 22.06.30
21.01.22 C1121668 07.08.27
8 LEMUEL ACOBA MARCAIDA MALE OS 1 PHILIPPINES MANILA 09.03.1998
MERSIN P7616752B 15.07.31
30.01.22 C1098314 18.07.27
9 JOHN DAVID DEL ROSARIO TORRES MALE OS 2 PHILIPPINES CALATAGAN BTS 25.03.1989
EVYAP P8136181B 09.11.31
30.01.22 C1445379 02.12.29
10 CHRAYSDENTH EBENEZER PRADO MALE OILER PHILIPPINES BACALOD CITY 20.10.1995
EVYAP P0840007B 27.02.29
30.01.22 C0961893 20.02.27
11 JOHN PAUL SUSVILLA MALE COOK PHILIPPINES BACALOD CITY 02.06.1992
EVYAP P7980313B 24.10.31
12/30/1899 0 12/30/1899
12/30/1899
12/30/1899 0 12/30/1899

MASTER OF MV MAX
MYKOLA SOSNOVSKY
 CREW LIST
Arrival Departure
X

1. Name of Ship / Callsign 2.GRT / NRT 3.Port of Arrival / Departure 4.Date of arrival / departure

MV MAX / D5ZO2 7532 / 3553 MISURATA / LIBYA 13.09.22

5.Port of registry / nationality of ship: 6.IMO Number 7. Port country arrived from / destination 8. Number of persons on board

MONROVIA / LIBERIA 9351098 SALERNO / ITALY 11

Number of Seaman's Book

Date of Joining Seaman's Book Expire Dates GMDSS
No Given Name, Family Name Sex Rank Nationality Place of Birth Date of Birth Certificates ID
Number of Passport Expire Number
Place of Joining Passport Dates
21.01.22 AB647781 1/2/2024
1 MYKOLA SOSNOVSKY MALE MASTER UKRAINE ODESSA 13.06.1982 12869/2015/11 0
MERSIN FB469141 5/8/2025
17.07.22 AB6216673 16.05.23
2 OLEKSIY SHEVCHENKO MALE CHF.OFF. UKRAINE KAZAKHSTAN 30.07.1969 11053/2016/06
VALENCIA FT131492 05.11.28
30.01.22 AB664973 05.08.25
3 GEORGII SELIVERSTOV MALE 2ND OFF. UKRAINE KHERSON 29.08.1990 14687/2015/07
MERSIN FJ958059 13.11.27
23.08.22 MK0007403 UNLIMITED
4 ANDREI SHEVCHENKO MALE CHF. ENG. RUSSIA USSR 14.08.1971
ALIAGA 726845699 25.11.2023
04.07.22 MK0213260 UNLIMITED
5 VSEVOLOD IUDEEV MALE 2ND ENG RUSSIA PITKARANTA 29.04.1995
AMBARLI 656812358 25.02.2024
30.01.22 C1031938 03.06.27
6 ANTHONY MARK FLORIDA TOBIAS MALE AB2 PHILIPPINES PIGCAWAYAN 19.10.1983
EVYAP P5715551B 03.11.30
21.01.22 C1110643 25.10.27
7 ELTON GILBUENA BATIANCILA MALE AB 1 PHILIPPINES CEBU CITY 09.11.1970
MERSIN P5251045B 22.06.30
21.01.22 C1121668 07.08.27
8 LEMUEL ACOBA MARCAIDA MALE OS 1 PHILIPPINES MANILA 09.03.1998
MERSIN P7616752B 15.07.31
30.01.22 C1098314 18.07.27
9 JOHN DAVID DEL ROSARIO TORRES MALE OS 2 PHILIPPINES CALATAGAN BTS 25.03.1989
EVYAP P8136181B 09.11.31
30.01.22 C1445379 02.12.29
10 CHRAYSDENTH EBENEZER PRADO MALE OILER PHILIPPINES BACALOD CITY 20.10.1995
EVYAP P0840007B 27.02.29
30.01.22 C0961893 20.02.27
11 JOHN PAUL SUSVILLA MALE COOK PHILIPPINES BACALOD CITY 02.06.1992
EVYAP P7980313B 24.10.31

MASTER OF MV MAX
MYKOLA SOSNOVSKY
 CREW BODY TEMPERATURE LIST
Arrival Departure
X

1. Name of Ship / Callsign 2.GRT / NRT 3.Port of Arrival / Departure 4.Date of arrival / departure

MV MAX / D5ZO2 7532 / 3553 MISURATA / LIBYA 13.09.22

5.Port of registry / nationality of ship: 6.IMO Number 7. Port country arrived from / destination 8. Number of persons on board

MONROVIA / LIBERIA 9351098 SALERNO / ITALY 11

CREW CREW CREW CREW CREW

No Given Name, Family Name Sex Rank TEMPRATURE TEMPRATURE TEMPRATURE TEMPRATURE TEMPRATURE
09.09.2022 10.09.2022 11.09.2022 12.09.2022 13.09.2022

1 MYKOLA SOSNOVSKY MALE MASTER 36.6'C 36.6'C 36.6'C 36.6'C 36.5'C

2 OLEKSIY SHEVCHENKO MALE CHF.OFF. 36.2'C 36.6'C 36.2'C 36.6'C 36.5'C

3 GEORGII SELIVERSTOV MALE 2ND OFF. 36.3'C 36.3'C 36.3'C 36.3'C 36.6'C

4 ANDREI SHEVCHENKO MALE CHF. ENG. 36.4'C 36.4'C 36.5'C 36.4'C 36.4'C

5 VSEVOLOD IUDEEV MALE 2ND ENG 36.4'C 36.4'C 36.4'C 36.4'C 36.5'C

6 ANTHONY MARK FLORIDA TOBIAS MALE AB2 36.3'C 36.3'C 36.3'C 36.6'C 36.3'C

7 ELTON GILBUENA BATIANCILA MALE AB 1 36.5'C 36.5'C 36.5'C 36.5'C 36.5'C

8 LEMUEL ACOBA MARCAIDA MALE OS 1 36.5'C 36.4'C 36.4'C 36.6'C 36.4'C

9 JOHN DAVID DEL ROSARIO TORRES MALE OS 2 36.6'C 36.6'C 36.6'C 36.6'C 36.6'C

10 CHRAYSDENTH EBENEZER PRADO MALE OILER 36.4'C 36.4'C 36.4'C 36.4'C 36.4'C

11 JOHN PAUL SUSVILLA MALE COOK 36.6'C 36.3'C 36.3'C 36.3'C 36.3'C

MASTER / SOSNOVSKY MYKOLA

 CREW LIST
Arrival Departure
x

1. Name of Ship / Callsign 2.GRT / NRT 3.Port of Arrival / Departure 4.Date of arrival / departure

MV MAX / D5ZO2 7532 / 3553 MISURATA / LIBYA 13.09.22

5.Port of registry / nationality of ship: 6.IMO Number 7. Port country arrived from / destination 8. Number of persons on board

MONROVIA / LIBERIA 9351098 SALERNO / ITALY 11

Number of Seaman's Book

Date of Joining Seaman's Book Expire Dates BODY TEMP BODY TEMP BODY TEMP
No Given Name, Family Name Sex Rank Nationality Place of Birth Date of Birth
29.07.2022 30.07.2022 31.07.2022
Number of Passport Expire
Place of Joining Passport Dates
21.01.22 AB647781 1/2/2024
1 MYKOLA SOSNOVSKY MALE MASTER UKRAINE ODESSA 13.06.1982 36.4'C 36.5'C 36.6'C
MERSIN FB469141 5/8/2025
17.07.22 AB6216673 16.05.23
2 OLEKSIY SHEVCHENKO MALE CHF.OFF. UKRAINE KAZAKHSTAN 30.07.1969 36.4'C 36.5'C 36.3'C
VALENCIA FT131492 05.11.28
30.01.22 AB664973 05.08.25
3 GEORGII SELIVERSTOV MALE 2ND OFF. UKRAINE KHERSON 29.08.1990 36.6'C 36.5'C 36.5'C
MERSIN FJ958059 13.11.27
23.08.22 MK0007403 UNLIMITED
4 ANDREI SHEVCHENKO MALE CHF. ENG. RUSSIA USSR 14.08.1971 36.4'C 36.5'C 36.6'C
ALIAGA 726845699 25.11.2023
04.07.22 MK0213260 UNLIMITED
5 VSEVOLOD IUDEEV MALE 2ND ENG RUSSIA PITKARANTA 29.04.1995 36.4'C 36.3'C 36.3'C
AMBARLI 656812358 25.02.2024
30.01.22 C1031938 03.06.27
6 ANTHONY MARK FLORIDA TOBIAS MALE AB2 PHILIPPINES PIGCAWAYAN 19.10.1983 36.4'C 36.5'C 36.6'C
EVYAP P5715551B 03.11.30
21.01.22 C1110643 25.10.27
7 ELTON GILBUENA BATIANCILA MALE AB 1 PHILIPPINES CEBU CITY 09.11.1970 36.4'C 36.6'C 36.2'C
MERSIN P5251045B 22.06.30
21.01.22 C1121668 07.08.27
8 LEMUEL ACOBA MARCAIDA MALE OS 1 PHILIPPINES MANILA 09.03.1998 36.4'C 36.5'C 36.4'C
MERSIN P7616752B 15.07.31
30.01.22 C1098314 18.07.27
9 JOHN DAVID DEL ROSARIO TORRES MALE OS 2 PHILIPPINES CALATAGAN BTS 25.03.1989 36.5'C 36.5'C 36.3'C
EVYAP P8136181B 09.11.31
30.01.22 C1445379 02.12.29
10 CHRAYSDENTH EBENEZER PRADO MALE OILER PHILIPPINES BACALOD CITY 20.10.1995 36.5'C 36.5'C 36.4'C
EVYAP P0840007B 27.02.29
30.01.22 C0961893 20.02.27
11 JOHN PAUL SUSVILLA MALE COOK PHILIPPINES BACALOD CITY 02.06.1992 36.5'C 36.5'C 36.6'C
EVYAP P7980313B 24.10.31

MASTER OF MV MAX
MYKOLA SOSNOVSKY
 SHIP'S STORES DECLARATION
Page No.

X Arrıval Departure 1 of 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

M/V MAX MISURATA / LIBYA 13.09.22

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA SALERNO / ITALY

6. Number of persons on board

11
9. Name of article 11. For Official Use

10. Quantity
DECK
CLEANING EQUIPMENTS
Rope 1700 mtrs Soap & Liquid Cleaner, e 65 pcs
Rope , Wire NIL mtrs Chemical 1500 ltr
Paint & Curing Agent 1700 ltrs
Thinner 230 ltrs
Grease 4 kg PYROTECHNICS
IMO Convention on Facilitation of International Maritime Traffic.

Glue 12 kg Line Throwing Rockets exp 08/2023 4 pcs

Ramnex 100 mtrs Parachute Rockets exp 08/2023 16 pcs
Hand Flares exp 04/2023 6 pcs
Smoke Signals exp 06/2023 2 pcs
PROVISION Manoverboard exp 05/2025 2 pcs
Flour / Un 100 kg
Black/Green Olives 15 can
Coffe/Kahve g BONDED & SLOP CHEST
Tea / Çay 25 kg
Ship Cigarettes 170 CRTN
Tea Pocket / Poşet çay 25 bx
Fetta Cheese / Beyaz P. 3 can
Edam Cheese / Kaşar P. 25 kg
Meat / Et 40 kg
Chicken /Tavuk 24 pcs BONDED & SLOP CHEST
Fish / Balık 5 kg Spirits NIL
Honey / Bal 6 btl Beer NIL
Jam / Reçel 100 kg Wine NIL
Margarine / Margarin 50 kg
Butter / Tereyağ kg
Macaroni / Makarna 180 kg
Fresh Vegetable / Taze Sbz. 30 kg BUNKER & LUBE OIL & FW
Fresh Fruit / Taze Meyve 40 kg VLSFO M/T
Potatoes and Dry Onion 35 kg D/O M/T
Dry Provision / Kuru Bak. kg L/O LTRS
Rice / Pirinç 50 kg FW M/T
Sunflower and Olive Oil 36 ltr
Milk / Süt 48 ltr
Egg / Yumurta 30 pcs
Sugar / Şeker 100 kg
Sugar Cubes / Küp Şeker 36 bx
IMO FAL Soft Drink 110 btl
FORM 3
12. Date and signature by master, authorised agent or officer

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 SHIP'S STORES DECLARATION
Page No.
Arrıval
x Departure 1 of 1
1. Name of ship 2. Port of arrival / departure 3. Date of arrival / departure

M/V MAX MISURATA / LIBYA 13.09.22

4. Nationality of ship 5. Port arrived from / Port of destination

LIBERIA SALERNO / ITALY

6. Number of persons on board

11
9. Name of article 11. For Official Use

10. Quantity
DECK
CLEANING EQUIPMENTS
Rope 1700 mtrs Soap & Liquid Cleaner, e 65 pcs
Rope , Wire NIL mtrs Chemical 704 ltr
Paint & Curing Agent 1250 ltrs
Thinner 220 ltrs
Grease 4 kg PYROTECHNICS
IMO Convention on Facilitation of International Maritime Traffic.

Glue 12 kg Line Throwing Rockets exp 08/2023 4 pcs

Ramnex 100 mtrs Parachute Rockets exp 08/2023 16 pcs
Hand Flares exp 04/2023 6 pcs
Smoke Signals exp 06/2023 2 pcs
PROVISION Manoverboard exp 05/2025 2 pcs
Flour / Un 125 kg
Black/Green Olives 15 can
Coffe/Kahve kg BONDED & SLOP CHEST
Tea / Çay 20 kg
Ship Cigarettes 184 CRTN
Tea Pocket / Poşet çay 20 bx
Fetta Cheese / Beyaz P. 3 can
Edam Cheese / Kaşar P. 48 kg
Meat / Et 120 kg
Chicken /Tavuk 80 pcs BONDED & SLOP CHEST
Fish / Balık 30 kg Spirits NIL
Honey / Bal 13 kg Beer NIL
Jam / Reçel 100 kg Wine NIL
Margarine / Margarin 45 pcs
Butter / Tereyağ kg
Macaroni / Makarna 200 kg
Fresh Vegetable / Taze Sbz. 60 kg BUNKER & LUBE OIL & FW
Fresh Fruit / Taze Meyve 60 kg VLSFO M/T
Potatoes and Dry Onion 50 kg D/O M/T
Dry Provision / Kuru Bak. kg L/O LTRS
Rice / Pirinç 125 kg FW M/T
Sunflower and Olive Oil 125 ltr
Milk / Süt 100 ltr
Egg / Yumurta 410 pcs
Sugar / Şeker 130 kg
Sugar Cubes / Küp Şeker 2 bx
IMO FAL Soft Drink 180 btl
FORM 3
12. Date and signature by master, authorised agent or officer

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 CREW'S EFFECTS DECLARATION
Page No.

(Name of Shipping Line, Agent etc.) X Arrival 0 Departure 1 of 1

1. Name of ship 2. Effects which are duitable or subject to prohibitions or restrictions

M/V MAX Date of arrival / departure 13.09.22

3. Nationality of ship Port of arrival / departure MISURATA / LIBYA
LIBERIA Cigarettes. Spirit
Other Articles 7. Signature
4. No 5. Family Name, Given Names 6. Rank or Rating

1 MYKOLA SOSNOVSKY MASTER NIL 1 GSM , 1 HDD , 1 USB , 1 SPEAKER, 1 LAPTOP, P.E
IMO Convention on Facilitation of International Maritime Traffic.

2 MOBILE 1 CAMERA 1 SILVER CHAIN 1 COLD RING 2 USB 1 TOUCHLIGHT,

2 OLEKSIY SHEVCHENKO CHF.OFF. NIL
P,E,

1 MACKBOOK, 1 TABLET. 2 MOBILE. 1 EBOOK, 1 HDD, 3 WATCH, 3 USB,

3 GEORGII SELIVERSTOV 2ND OFF. NIL
GOLD RING, GOLD NECKLESS, 2SILVER RING, 1 EYRPODS P.E.

1 LAPTOP 1 MOBELE 1 HDD 2 GOLDRING 1 SUNGLASSES SILVER CHAIN

4 ANDREI SHEVCHENKO CHF. ENG. NIL
AND CROSS

5 VSEVOLOD IUDEEV 2ND ENG NIL 1 LAPTOP 1 HDD 1 MOBILE P E

6 ANTHONY MARK FLORIDA TOBIAS A/B NIL 2 MOBILE 1 WATCH 1 SPEAKER 1 HAIER CLIPPRE P,E

1 LAPTOP 3 MOBILE 1 HDD 1 POWERBANK 1 USB 1 CAMERA 1 WATCH 1

7 ELTON GILBUENA BATIANCILA AB 1 NIL
HAIRCLIPPER P.E

8 LEMUEL ACOBA MARCAIDA O/S NIL 2 MOBILE 1 WATCH P.E

1 LAPTOP 1 MOBILE 1 WATCH 1 HEADSET 2 GOLD NEKLESS 1GOLD RING 1

9 JOHN DAVID DEL ROSARIO TORRES O/S NIL
HDD 1 POWERBANK P.E

10 CHRAYSDENTH EBENEZER PRADO OILER NIL 1 LAPTOP 1 MOBILE 1 HDD 4 USB 1 POWERBANK 1 WATCH 1 SPEAKER P.E

11 JOHN PAUL SUSVILLA COOK NIL 2 MOBILE 1 HEADSET 1 HDD P.E

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 CREW'S CURRENCY DECLARATION
Page No.

(Name of Shipping Line, Agent etc.) X Arrival 0 Departure 1 of 1

1. Name of ship 2. Port of arrival/departure Date:
M/V MAX MISURATA / LIBYA 13.09.22
3. Nationality of ship

LIBERIA CURRENCY
IMO Convention on Facilitation of International Maritime Traffic.

7. Signature
4. No 5. Family Name, Given Names 6. Rank or Rating

1 MYKOLA SOSNOVSKY MASTER

2 OLEKSIY SHEVCHENKO CHF.OFF.

3 GEORGII SELIVERSTOV 2ND OFF.

4 ANDREI SHEVCHENKO CHF. ENG.

5 VSEVOLOD IUDEEV 2ND ENG

6 ANTHONY MARK FLORIDA TOBIAS AB

7 ELTON GILBUENA BATIANCILA AB 1

8 LEMUEL ACOBA MARCAIDA OS

9 JOHN DAVID DEL ROSARIO TORRES OS

10 CHRAYSDENTH EBENEZER PRADO OILER

11 JOHN PAUL SUSVILLA COOK

14 0 0 0

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 SHIPS MONEY DECLARATION

X Arrival Departure

Page No 1
1. Name of Ship M/V MAX 2.Arrıval Port MISURATA / LIBYA 3.Date of Arrival/Dep. 13.09.22
4. Nationality LIBERIA 5.Port of Departure SALERNO / ITALY

5629 $
CFIMT
IMCO

12.Date and signature by master, authorised agent or officer IMCOFAL FORM 5/156

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 M/V MAX DATE : 13.09.22
PORT : MISURATA / LIBYA

LAST PORTS OF CALL LIST

NO PORTS COUNTRY UNCTAD LOCODE ARRIVAL DATE DEPARTURE DATE S. LEVEL

1 SALERNO ITALY ITSAL 11.09.22 11.09.22 LEVEL 1

2 GENOVA ITALY ITGOA 09.09.22 10.09.22 LEVEL 1

3 BARCELONA SPAIN ESBCN 07.09.22 08.09.22 LEVEL 1

4 CASTELLON SPAIN ESCAS 06.09.22 07.09.22 LEVEL 1

5 VALENCIA SPAIN ESVLC 05.09.22 06.09.22 LEVEL 1

6 ORAN ALGERIA DZORN 03.09.22 05.09.22 LEVEL 1

7 ALGER ALGERIA DZALG 01.09.22 03.09.22 LEVEL 2

8 ANNABA ALGERIA DZAAE 31.08.22 31.08.22 LEVEL 1

9 GEBZE TURKEY TRGEB 26.08.22 27.08.22 LEVEL 1

10 AMBARLI TURKEY TRAMB 25.08.22 26.08.22 LEVEL 1

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 SHIP PRE-ARRIVAL SECURITY INFORMATION FORM
FOR ALL SHIPS PRIOR TO ENTRY INTO THE PORT OF AN EU MEMBER STATE
(SOLAS REGULATION XI-2/9 AND ARTICLES 6,1 OR REGULATION (EC) No. 725/2004)

TO BE SUBMITTED TO THE COMPETENT AUTHORITY FOR MARINE SECURITY OF THE PORT OF ARRIVAL
Particulars of the ship and contact details
IMO Number 9351098 Name of ship M/V MAX
Port of registry MONROVIA Flag State LIBERIA
Type of ship CONTAINER Call Sign D5ZO2
Gross Tonnage 7532 Inmarsat call Numbers (if available) 0092870773944760
CSO name & 24 CAPT.SERKAN KARAMANLI /
Name of Company TOBA SHIP MANAGEMENT
hour contact details +90 216 505 2500
Port of arrival MISURATA / LIBYA Port facility of arrival (ifknown) DISCHARGING + LOADING
Port and port facility information
Expected date and time of arrival of the ship in port
07.09.2022
(ETA) (B/4.39.3 ISPS Code
Primary purpose of call CARGO OPERATIONS
Information required by SOLAS regulation XI-2/9.2.1

Does the ship have a valid International Ship Issued by (name Expiry date
Security Certificate (ISSC)? (XI-2/9.2.1.1) YES IISSC NO - why not? of Administration or RSO)
BV 07.12.2026

Does the ship have an Security Level at which the ship is currently Security Security Security
approved SSP on board? YES NO operating? (XI-2/9.2.1.2)
Level
Level 1 2 Level 3

Location of ship at the time this report is made

(B/4.39.2 ISPS Code)
List the last ten calls at port facilities in chronological order (most recent call first):(XI-2/9.2.1.3)
No. Date from Date to (dd/mm/yyyy) Port Country UNLOCODE (if Port facilitySecurity
(dd/mm/yyyy) available)
Level
1 11.09.22 11.09.22 SALERNO ITALY ITSAL CONTAINER TERMINAL LEVEL 1
2 09.09.22 10.09.22 GENOVA ITALY ITGOA CONTAINER TERMINAL LEVEL 1
3 07.09.22 08.09.22 BARCELONA SPAIN ESBCN CONTAINER TERMINAL LEVEL 1
4 06.09.22 07.09.22 CASTELLON SPAIN ESCAS CONTAINER TERMINAL LEVEL 1
5 05.09.22 06.09.22 VALENCIA SPAIN ESVLC CONTAINER TERMINAL LEVEL 1
6 03.09.22 05.09.22 ORAN ALGERIA DZORN CONTAINER TERMINAL LEVEL 1
7 01.09.22 03.09.22 ALGER ALGERIA DZALG CONTAINER TERMINAL LEVEL 2
8 31.08.22 31.08.22 ANNABA ALGERIA DZAAE CONTAINER TERMINAL LEVEL 1
9 26.08.22 27.08.22 GEBZE TURKEY TRGEB CONTAINER TERMINAL LEVEL 1
10 25.08.22 26.08.22 AMBARLI TURKEY TRAMB CONTAINER TERMINAL LEVEL 1
YES NO
Did the ship take any special or additional security measures,beyond those in approved SSP? If the answer is YES, indicate
below the special or additional security measures taken by the ship. (XI-2/9.2.1.4.)

No.
Special or additional security measures taken by the ship
as above
1

--
2

--
3

/A
4

N
5

---
6
7
8
9
10
-
List the ship-to-ship acivities, in chronological order (most recent first), which have been carried out during the period of the last ten calls at port facilities
listed above. Expand table below or continue on separate page if necessary - insert total number of ship-to-ship activities:

Have the ship security procedures specified in the approved SSP been maintened during each of these ship-to-ship activities? YES NO
(XI-2/9.2.1.5)

If NO, provide details of the security measures applied in lieu in the final column below
No. Date from Date to (dd/mm/yyyy) Location or Longitude and Latitude Ship-to-ship activity Security measures applied in lieu
(dd/mm/yyyy)

1
2
 3

A -- --
4
5

- -- N /
-
6
7
8
9
10
General description of the cargo aboard the ship (XI-2 / 9.2.1.6. e General cargo in containers
B/4.39.4 ISPS Code)
If YES, confirm Dangerous Goods
Is the ship carrying any dangerous substances as cargo covered by any Classes Manifest (IMO FAL Form 7)(or relevant
YES NO
1,2.1,2.3,3,4.1,5.1,6.1,6.2,7 or 8 of the IMDG Code? extract) is attached TBA

Confirm a copy of the ship's passenger

list is attached (XI-2 / 9.2.1.6 e B/4.39.6
Confirm a copy of ship's crew list is attached (I.M.O. FAL Form 5) (XI-2 /
9.2.1.6 e B/4.39.4 ISPS Code) YES ISPS Code) YES

Other security related information

Is there any security-related matter you wish to

report? NO Provide details: NO

Agent of ship at intended port of arrival

Name: Roca Castellón Consignaciones S.L. Contact details (tel.no.): Tel: 964284488
general e-mail: [email protected]
Identification of person providing the information
Title or position (Delete as appropriate) Name: Signature:
MYKOLA SOSNOVSKY
Master / SSO / CSO / Ship’s agent (as above)
Date/Time/Place of completion of report : 07.09.22
 NIL LIST
X Arrıval
0 Departure

Page No 1
1. Name of Ship M/V MAX 2.Port of arrival / departure MISURATA / LIBYA 3.Date of of arrival / departure 13.09.22
4. Nationality LIBERIA 5 Port arrived from / Port of destinationSALERNO / ITALY

ARM/GUN NIL

AMMUNITION NIL

STOWAWAY NIL

PASSENGER NIL

DRUG NIL

ANIMALS NIL

6.Date and signature by master, authorised agent or officer IMCO FAL FORM

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 PASSANGER LIST
X Arrıval
0 Departure

Page No 1
1. Name of Ship M/V MAX 2.Port of arrival / departure MISURATA / LIBYA 3.Date of of arrival / depa 13.09.22
4. Nationality LIBERIA 5 Port arrived from / Port of destinatio SALERNO / ITALY

PASSENGER NIL

6.Date and signature by master, authorised agent or officer IMCO FAL FORM

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 DENİZ SAĞLIK BİLDİRİMİ
MARITIME DECLARATION OF HEALTH
Yabancı limanlardan gelen gemilerin kaptanı tarafından doldurulup yetkili makamlara teslim edilecektir.
To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports.

MISURATA / LIBYA limanında, 13.09.22 tarihinde teslim edilmiştir.

Submitted at the port of Date

Geminin ya da iç su gemisinin adı M/V MAX Kayıt / IMO Numarası 9351098

Name of ship or inland navigation vessel Registration / IMO No

geldiği yer SALERNO / ITALY gideceği yer ALIAGA / TURKEY

arriving from sailing to

(Tabiiyeti)/(Geminin bayrağı) MONROVIA Gemi kaptanının adı MYKOLA SOSNOVSKY

(Nationality)/(Flag of vessel) Master's name

(Geminin) grostonu 7532 ( İç su gemisinin) tonajı

Gross tonnage (ship) Tonnage (inland navigation vessel)

Gemide geçerli bir Sağlık Kontrolünden Muafiyet / Sağlık Kontrol Sertifikası var mı?
Valid Sanitation Control Exemption / Control Certificate carried on board?

Evet X Hayır Düzenlendiği yer AMBARLI/TURKEY Tarih 13.05.2022

yes no Issued at date . .
Yeniden incelenmesi gerekiyor mu? Evet Hayır X
Re-inspection required ? yes no

Gemi / Deniz aracı Dünya Sağlık Örgütü tarafından tesbit edilen etkilenmiş bir bölgeye uğradı mı?
Has ship/vessel visited an affected area identified by the World Health Organization?

Evet Hayır Uğrak limanı ve tarih

yes no X Port and date of visit

Yolculuğun başlangıcından itibaren veya son otuz gün içinde, hangisi daha kısa ise, uğrak limanların çıkış tarihleri ile birlikte listesi :
List ports of call from commencement of voyage with dates of depature, or within past thirty days, whichever is shorter:
SALERNO ITALY 11.09.22
GENOVA ITALY 10.09.22
BARCELONA SPAIN 08.09.22
CASTELLON SPAIN 07.09.22
VALENCIA SPAIN 06.09.22
ORAN ALGERIA 05.09.22
ALGER ALGERIA 03.09.22
ANNABA ALGERIA 31.08.22
GEBZE TURKEY 27.08.22
AMBARLI TURKEY 26.08.22

Varıştaki yetkili makamın talebi üzerine, mürettebatı, yolcuları veya uluslar arası yolculuğa başlandığından itibaren veya son otuz gün
içinde, hangisi daha kısa ise, gemiye / deniz aracına binmiş diğer kişileri, bu süre zarfında uğradığı tüm limanları / ülkeleri içerecek
şekilde listeleyiniz (ilave isimleri ilişikteki listeye ekleyiniz) :
Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined
ship/vessel since international voyage began or within past thirty days, whichever is shorter, including all ports/countries visited
in this period (add additional names to the attached schedule):

(1) İsim bindiği yer (1) (2) (3)

Name Andrei Shevchenko joined from: 23.08.22 Aliaga
(2) İsim bindiği yer (1) (2) (3)
Name joined from:

(3) İsim (1) (2) (3)

Name joined from:
(4) İsim bindiği yer (1) (2) (3)
Name joined from:

5 İsim joined from: (1) (2) (3)

6 Name joined from: (1) (2) (3)

İsim bindiği yer (1) (2) (3)
7 Name joined from:

Gemideki mürettebatın sayısı 11

Number of crew members on board

Gemideki yolcuların sayısı N/A

Number of passengers on board

Sağlık Soruları
Health questions
(1) Yolculuk boyunca gemide bir kaza sonucu olanlar dışında ölen yolcu oldu mu? Evet Hayır
If any person died on board during the voyage otherwise than as a result of accident? yes no X
Evet ise, ayrıntıları ilişik tabloda belirtiniz. Toplam ölü sayısı
if yes, state particulars in attached schedule. Total no.of deaths

(2) Gemide ya da uluslararası yolculuk esnasında bulaşıcı-mikrobik olduğundan şüphelendiğin herhangi bir hastalık var mı?
Is there on board or has there been during the international voyage any case of dissease which you suspect to be of an infectious nature?

Evet Hayır Evet, ise ayrıntıları ilişikte belirtiniz.

yes X no If yes, state particulars in attached schedule.

(3) Yolculuk esnasında, hasta yolcuların toplam sayısı, normalden / beklenilenden daha mı fazladır?
Has the total number of ill passengers during the voyage been greater than normal/expected?

Evet Hayır Ne kadar hasta kişi var?

yes X no how many ill persons?

(4) Şu anda gemide hasta kişi var mı? Evet Hayır Evet ise, ayrıntıları ilişikte belirtiniz.
Is there any ill person on board now? yes X no If yes, state particulars in attached schedule.

(5) Bir tıp doktoruna danışıldı mı? Evet Hayır Evet ise, yapılan tıbbi tedavi veya önerilerin ayrıntılarını ilişikte belirtiniz.
Was a medical pactitioner consulted? yes X no If yes, state particulars of medical treatment or advise provided in attached schedule.

(6) Gemide bulaşıcı-mikrobik hastalığın yayılmasına yol açabilecek bir durum biliyor musunuz?
If you aware of any condition on board which may lead to infection or spread of disease?

Evet Hayır Evet, ise ayrıntıları ilişikte belirtiniz.

yes X no If yes, state particulars in attached schedule.

(7) Gemide herhangi bir sağlık önlemi uygulanmış mıdır? (örn. karantina, tecrit, dezenfeksiyon veya dekontaminasyon).
If any sanitary measure (e.g. guarantine, isolation, disinfection or decontamination) been applied on board?

Evet Hayır Evet ise, yeri, türü ve tarihini belirtiniz.

yes X no if yes, specify type, place and date

(8) Gemide kaçak yolcu bulundu mu? Evet Hayır If yes, where did they join the ship (if known)?
Have any stowaways been found on board? yes X no

Evet ise, bunlar gemiye (biliniyorsa) nereden binmişlerdir.

If yes, where did they join the ship (If known)?

(9) Gemide hasta hayvan ya da evcil hayvan bulunmakta mıdır? Evet Hayır
Is there a sick animal or pet on board? yes X no

Not : Gemi tabibi yoksa, kaptan şu belirtileri, bulaşıcı-mikrobik türdeki bir hastalığın varlığından şüphelenmek için olarak dikkate almalıdır:
In the absence of a surgeon,the master should regard the following symptoms as grounds for suspecting the existence of a disease of an infectious nature:

(a) birkaç gün süren ateş ile birlikte olan; (i) bitkinlik (ii) bilinç azalması (iii) beze şişmesi (iv) sarılık (v) öksürük veya nefes darlığı (vi) alışılmadık kanamalar; veya (vii) felç.
fever, persisting for several days or accompanied by (i) prostration; (ii) decreased consciousness; (iii) glandular swelling;(iv) jaundice; (v) cough or shortness of breath;
(vi) unusual bleeding; (vii) paralysis.

(b) ateşli veya ateşsiz :(i) deride akut her hangi bir tipte döküntü veya pullanma; (ii) ciddi kusma (deniz tutması haricinde); (iii) ciddi ishal; veya (iv) tekrarlayan bayılmalar.
with or without fever: (i) any acute skin rash or eruption; (ii) severe vomiting (other than sea sickness); (iii) severe diarrhoea; or (iv) recurrent convulsions.

Ben, bildiğime ve inanışlarıma göre, bu Sağlık Bildiriminde (ilişkileri ile birlikte) sorulan sorulara verdiğim cevap ve ayrıntıların doğru ve hakikate uygun olduklarını beyan ederim.
I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief.

Tarih 13.09.22 İmza MYKOLA SOSNOVSKY Mukabil İmza Gemi tabibi (varsa)
Date Signed Kaptan Countersigned
 MEDICINE LIST
Arrival X
Departure 1.Date 13.09.22
2. Port arrival MISURATA / LIBYA
3. Port of arrival from SALERNO / ITALY
4.Name of ship : M/V MAX 6. Quantities and expire dates of the medicines / medications
5.Nationality of ship : LIBERIA onboard
NO // KOD Name of the Medicine 6.Quantity EXP. DATE NO // KOD Name of the Medicine 6.Quantity EXP. DATE
500 tab
1 // M/1.b.1 Isosorbıdenıtraat 20mg,30tabl 60 tab 11.2023 34// M/8.a Salt, sugar coated 250tabl 11.2022
AdalatOros/Nıfedıpıne 30mg tablet,
2// M/1.b.2 35// M/9.a.1
30pc
3// M/2.a.2 Seaseeknes tablet 160 pcs .01.2026 36// M/9.a.2 obramis eye drop 5 psc .12.2023

4// M/2.a.3 magnesium hydroxid 200 gr .10.2024 37// M/9.a.4 Alchole Dıl.70%,Methyl.,300ml 1btl 04.2023

5// M/2.b.2 Domperıdon 10mg tablet 30 pcs 60 tab 12.2022 38// M/9.a.5 Fucidin 2% cream 30g 3 psc 01.2023

6// M/2.c Glycerol suppository 4G / 1G 10 cap 03.2023 39// M/9.a.6 METPAMID tablet 104 tab 7.2026

2x12.2023
7// M/2.d.1 Oral Rehydratıon Salt, 12sach 36 sach 40// M/9.a.7 Bacytracın-Neomycın oıntm 30g 10.2022
1x04.2023 4 psc

9// M/2.e Norit Carbomıx 50gr 1 bottle 2 btl 2.2024 42// M/9.a.9 chartcoal liquid 2 pcs .03.2023

Emergency Eyewash Braun 250 ml,500

10// M/2.f.1 Anti-Haemorroıd Supp, 10pcs 30 tab 07.2023 43// M/9.b.1 3 btl 6.2023
ML

11// M/2.f.2 Mebandozole 30 tab 04.2024 45// M/9.b.6 chloroquine 200mg 120 tab .06.2023

12// M/3.b.1 Indometacın 50mg capsule 28 pcs .04.2023 46// M/9.b.5 Pilocarpine HCL eyedrops 2% 15ml 2 psc 09.2023
13// M/1A1 Hydrocartisone 30 gr 2 .01.2026 47// M/9.d Chloorhex.Dıgluc.Mouthw 200ml 5 btl 07.2023
03.2023
14// M/5.a Eyewash or eye irrigation solution 2 btl 48// M/9.e.1
30 tab
15// M/6.a.3 Theophyllın Retart 200mg 30 tablet 10.2022 49// M/9.e.4 Thrombocid 15mg GEL 1 psc 04.2025

OXYMETAZOLINE
16// M/6.b.2 14 btl .01.2024 50// M/9.e.2
DROPS(ILLIADIN)

17// M/6.c.1 muscoflex 4 mg 60 tab .05.2025 51// M/9.b.3 Vitamin C 40 tab 8.2023

18// M/6.c.2 Nascopıne HCL 300ml 4 btl 10.2022 52// M/7.b.2 Maxidrops 30 psc 08.2023

4 psc 08.2024
19// M/7.a.1 Metil Salsilat (bengay) 3 psc 8.2026 53// M/6.a.1 Silvadiazin 1%
+3 psc .11.2026

20// M/7.a.2 Lidocaine w/o adrenaline 10 amp .02.2027 54// M/3.a.3 Inflased tetracıne(diclefenac eye drop) 4 tube 11.2022
.01.2024 +
21// M/7.a.3 GAVISCON sodyum alıjınat btl 55// M/3.a.2 visine tetrahıdrolozın 3 psc 02.2023
01.2023
22// M/7.a.4 PERMETHRIN %5 (KWELLADA) 3 psc 05.2024 Zınc oxıde cream 10 tube 04.2024
Baticonol povıdıne ıodıne solutıon 5 btl 01.2023
23// M/7.b.1 Dıclactıve %1 2 psc '02.2024 57// M/9.e.3 5 btl
100 ml '09.2023
24// M/7.d.1 Talcid Hydrotalcid 14 tab '12.2024 58// M/9.e.3 Dermosept oksijenli su 300 ml 1 psc .01.2024

25// M/7.e. siprogut ear drop 5 pcs .12.2023 59M/6.c.1

26// M/7.d.3 ibuprofen 400 100 tab .02.2027 60M/6.c.1 Dolgit merhem 1 psc .10.2024

27// M/7.d.4 PERMETHRIN %1 300ml 1 btl 3.2023 61M/6.c.1 Difenak (volteren) 2 psc .10.2023

28// M/7.d.5 62M/7.f.1 tetraticiclin oinment 8 pcs .10.2023

29// M/7.d.6 Loperamide 60 tab 08.2025 vitamin C 120 caps .01.2024

30// M/7.d.7 Tetracine 0.5% Eye Drops USP 8 psc 02.2023 59 Coolıng gel block fredge blue one 11 psc

69 Metilergonovin maleat 25 tab 01.2023 60 Ethyl alchole 99.9% 500ml

32// M/2.a.4 Cloves oıl(DİŞİNOL) 30 mj 3 psc 02.2023 61 Gelatin polysuccinate 40gr 500ml

33// M/1.a Beklometazon Dipropıyonat/allergy 2 tube 01.2026 62

63 Isotonic Saline Solution 500ml 8 psc 03.2023 65 antıseptıc solutıon 1000 ml 9 btl 11.2022

64 Sodium Chloride 1000ml 66 MARMARA 80% hygıenıc lıquıd hand 7 btl 5.2023

68 ibuprofen dolgit ointment 50 gr 1 psc 10.2024 67

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 NARCOTIC MEDICINE LIST
DATE : 13.09.22
x Arrıval Departure

Port of arrival / departure MISURATA / LIBYA

1.Name of ship : M/V MAX 2. Quantities and expire dates of the narcotics on board

3.Nationality of ship : LIBERIA PORT OF ARRIVAL FROM / PORT

OF DESTINATION SALERNO / ITALY
MEDICINE NO 5. Name of the narcotics 6. Quantity 7. Date of expire
1 Tramadol 100 MG/2ML 10 ampoules 01.2023
2 Haloperidol 5MG/ML inj. Amp. 1ml, 10 ampoules 01.2023
3 Naloxon 0.4mg/1ml INJ. 5 ampoules 02.2023
4 Furosemide 20MG/2ML/5AMP. 10 ampoules 07.2026
5 Desal 40 mg tab 100 tablets 05.2026
6 Hydroxyzine HCL 25mg 100 tablets 01.2023 / 12.2022
7 Imovane/Zopiclone 7.5mg tablet 150 tablet 10.2022
8 Amoxycillin 500 mg 60 tab 12.2023
9 Majezik fluıbıprofen 15 tab 01.2026
10 Paracetamol 500 mg 176 tab 05.2023
11 Erytromycin 500 mg 70 tab 02.2026
12 Salbutamol inhaler 200 doses 3 pcs 12.2022
13 Aspirine 500 mg acetylselıcylıc acıd 280 pcs 02.2023
14 Tylolhot parecetamol 18 psc 07.2023
15 Suprafen 400 mg ıbuprofen 26 tab 11.2025
16 Adrenalin 1 mg 10 ampoules 05.2023
17 Theraflu 650 mg parecetamol 10 tab 04.2023
18 A-ferin forte parecetamol 60 tab 10.2025
19 Klavunat 875 mg amoxıcıllın 10 tab 01.2024
20 Tetanus vaccin 0,5ml 5 ampoules 01/07/2023
21 Dıcloron dıclofenac sodıum 28 tab 01/11/2023
22 Metoprolol 100 mg 60 tab 01/09/2023
23 Dexamethasone amp 10 ampoules 01/12/2024
24 Phytomenadione 5 AMP 10 PCS 01.2023
25 Metoclopramide 10mg/2ml 21 ampl 10.2022
26 Propranolol CF 40mg 50tab 50 pcs 07.2024
27 Cefuroxime 750mg 5 amp 10 pcs 11.2022
28 Methylprednısolon 40mg 1amp/ 30tablet 6 PCS 02.2023
29 Ventolın ınjectıon 0.5mg/ml 5*1ml 5 ampl 10.2022
30 Cetirizine tabs 10mg 30 pcs 06.2024
31 Ceftrıaxone amp. 1g-IM (Desefin) 5 amp /19 amp 12.2022 / 11.2023
32 Aciclovir 400 mg 75 pcs 01.2024
33 Azitromycin 500 mg 6 tabs 02.2024
34 Atropine amp, antidotes 20 amp 09.2026
35 Doxycyline 56 tab 01.2027

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 YELLOW FEVER

X Arrival 0 Departure

1. Name of ship 2. Port of arrival/departure

M/V MAX MISURATA / LIBYA

4.DATE 13.09.22
3. Nationality of ship

LIBERIA
4. No 5. Family Name, Given Names 6. Rank or Rating VACCINATION

1 MYKOLA SOSNOVSKY MASTER 07.08.2015

2 OLEKSIY SHEVCHENKO CHF.OFF. 09.01.2009

3 GEORGII SELIVERSTOV 2ND OFF. 19.01.2009

4 ANDREI SHEVCHENKO CHF. ENG. 18.10.2007

5 VSEVOLOD IUDEEV 2ND ENG 12.12.2015

6 ANTHONY MARK FLORIDA TOBIAS AB 2 09.09.2009

7 ELTON GILBUENA BATIANCILA AB 1 05.01.2011

8 LEMUEL ACOBA MARCAIDA OS 1 25.10.2021

9 JOHN DAVID DEL ROSARIO TORRES OS2 27.04.2011

10 CHRAYSDENTH EBENEZER PRADO OILER 28.04.2016

11 JOHN PAUL SUSVILLA COOK 22.04.2014

14 0 0 30/12/1899

MASTER OF M/V MAX

MYKOLA SOSNOVSKY
 COVID-19

X Arrival 0 Departure

1. Name of ship 2. Port of arrival/departure

M/V MAX MISURATA / LIBYA

4.DATE 13.09.22
3. Nationality of ship

LIBERIA
4. No 5. Family Name, Given Names 6. Rank or Rating VACCINATION

1 MYKOLA SOSNOVSKY MASTER 13.01.2022

2 OLEKSIY SHEVCHENKO CHF.OFF. 23.09.2021

3 GEORGII SELIVERSTOV 2ND OFF. 05.10.2021

4 ANDREI SHEVCHENKO CHF. ENG. 01.06.2022

5 VSEVOLOD IUDEEV 2ND ENG 27.05.2022

6 ANTHONY MARK FLORIDA TOBIAS AB 2 09.09.2021

7 ELTON GILBUENA BATIANCILA AB 1 23.11.2021

8 LEMUEL ACOBA MARCAIDA OS 1 13.01.2022

9 JOHN DAVID DEL ROSARIO TORRES OS2 23.12.2021

10 CHRAYSDENTH EBENEZER PRADO OILER 21.01.2022

11 JOHN PAUL SUSVILLA COOK 13.10.2021

14 0 0 30/12/1899

MASTER OF M/V MAX

MYKOLA SOSNOVSKY