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Road Tanker Transfer Form

Transfer Form Checklist

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

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

if Other, please describe

Vehicle Description

Registration Number

Gross Vehicle Mass (GVM) tonnes

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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