Fuel Transfer Form

Fuel Transfer Form

Form FP001/5 - TRANSFER OPERATIONS

Application / Approval to Conduct Transfer Operation(s) - Fuel & Other Liquids

Details of Proposed Transfer Operation(s)

Select Port *
Cairns
Cairns Marlin Marina
Mourilyan
Karumba
Thursday Island
Horn Island
Skardon River

Vessel Name

Berth

Date of Transfer

Time of Transfer

Type of Transfer *
Ship to Shore
Shore to Ship
Type of Cargoes *
Fuel
Waste Oil
Hydraulic Oil
Grey Water
Black Water (Sewage)
Hull / Product washings
Bilge Oil
Other.....

If Other, please describe

Vehicle Description

Registration Number

Gross Vehicle Mass (GVM) - tonne

Fuel Type

Transfer Amount (litres)

Conditions

1. Full compliance with all applicable legislation including: --- International Marine Dangerous Goods Code --- Transport Operations (Marine Safety) Act 1994 --- Environmental Protection Act 1994 --- Transport Infrastructure Act 1994 - Port Notices --- International Safety Guide for Oil Tankers & Terminals (ISGOTT) 2. Ports North reserves the right to withdraw this approval at any time without notice

Ships Agent / Vessel Master / Contractor

-- as Agent for the Vessel, I acknowledge responsibility and liability for all directions between the Vessel Master and Transfer Contractor and accept responsibility for preventing spills or unsafe acts. -- as Master/Captain/Chief Engineer, I acknowledge responsibility and liability for all activities aboard my vessel and accept responsibility for preventing spills or unsafe acts. -- as appointed Transfer Operator/Contractor, I acknowledge responsibility and liability for all transfer procedures between the Vessel and Tanker/Containers and accept responsibility for preventing spills or unsafe acts.

Name

Company

Email

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