Name of Ship:

IMO Number:

Flag:

Type of Ship:

Tonnages: (Format: GRT / NRT / DWT)

Owners: (Address & Contact Details)

Managers: (Address & Contact Details)

Last Port / Next Port:

Cargo Details: (Type & Quantity)

Date & Time of Incident: (LT/UTC)

Position: (LAT / NS LONG / EW)

Nearest Landmark / Location:

Port / Town / Anchorage Area:

Country / Nearest Country:

Status (Berth /Anchored / Steaming):

Own Ship's Speed:

Ship's Freeboard During Attack:

Weather During Attack: Wind (Speed & Direction)

Weather During Attack: Sea

Weather During Attack: Swell

Type of Attack (Boarded / Fired Upon / Attempted):

Consequences for Crew, Ship and Cargo, Any Crew Injured / Killed and Items / Cash Stolen:

Area of the Ship being Attacked:

Number of Pirates / Robbers:

Dress Code / Physical Appearance of Pirates:

Language Spoken:

Distinctive Details:

Craft Used:

Closest Point of Approach (CPA):

Method of Approach:

Duration of Attack:

Aggressive / Violent: (YES / NO) Aggressive / Violent: (YES / NO)YesNo

Weapons Sighted (YES / NO) Weapons Sighted (YES / NO)YesNo

Weapon Type:

Weapons Used (YES / NO) Weapons Used (YES / NO)YesNo

Damage Caused (YES / NO) Damage Caused (YES / NO)YesNo

Details of Damage (Please give as much Information as possible)

Ladder Sighted (YES / NO) Ladder Sighted (YES / NO)YesNo

Other Boarding Equipment Sighted (Please give Details):

Action Taken by Master and Crew:

Was Incident Reported to the Coastal Authority? If Yes, to whom?

Action taken by the Authorities:

Anti Piracy Measures Employed (Please Specify):

Was Private Security Team Embarked? And were they Armed or Unarmed:

Number of Crew / Nationality:

Phone Number:

Email:

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