船船 舶舶 载载 运运 固固 体体 散散 装装 货货 物物 申申 报报 单单 Declaration Form for Solid Bulk Cargoes Carried By Ship船 名： Ships Name: 航 次： Voyage No.: 进港 Arrival始发港： Port of Departure: 抵港时间： Time of Arrival: 国 籍： Nationality: 经 营 人： Manager: 出港 Departure作业泊位： Berth: 作业时间： Time of Loading: 散装货物运输名称 Bulk Cargo Shipping Name组别 Group类别 Class危规编号 UN No.总 重 量 Weight in Total卸 货 港 Port of Discharging装载位置 Location of Stowage备 注 Remarks兹声明根据船舶装载固体散装货物安全和防污染规定，本轮具备装载上述货物的适装条件，货物配装符合要求，货物资料齐全。申报内容准确无 误。 I hereby declare that, in accordance with the provisions of the safe transportation of solid bulk cargoes by ships and pollution prevention, this ship has met the requirements of fitness for carrying the above declared goods; Cargo stowage is properly planned according to the requirements; The documentation of the cargo is complete and the contents of the declaration are true and correct. 附送以下单证、资料 The following documents and information are submitted in addition.轮船长/申报员:Master / Declarator: 船长/申报员证书编号:Certificate No.: 船舶/代理人（盖章）Ship / Agent (Seal)日期:Date:主 管 机 关 签 证 栏 Remarks by the Administration紧急联系人姓名、电话、传真、电子邮箱： Emergency Contact Persons Name, Telephone No., Fax, and E-mail:此申报单一式三份，其中两份退申报人留持并分送港口作业部门，一份留主管机关存查。 This declaration should be made in tripartite, one is kept by the Administration for file, and two for the declarer and port operator respectively. 中华人民共和国海事局监制中华人民共和国海事局监制