\nApplication for Ship Sanitation Certificate<\/legend>\r\n\r\n

\n\n\n\n\n\n

\r\n Agent\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Vessel\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Gross tonnage of vessel\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Flag\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Previous port of call\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Next port of call\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Anchorage\r\n *<\/span>\r\n <\/label>\r\n \r\n

Only vessels berthed alongside or at the Western\/Northern anchorages.<\/div>\r\n \r\n<\/div>\n

\r\n Date inspection required\r\n *<\/span>\r\n <\/label>\r\n \r\n

NB in accordance with Regulation 16 Public Health (International Health) a minimum of 48 hours\u2019 notice must be given Rules 2014 <\/div>\r\n \r\n<\/div>\n

\r\n ETA\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Time\r\n *<\/span>\r\n <\/label>\r\n \r\n

HH\/MM Hrs<\/div>\r\n \r\n<\/div>\n

\r\n In ballast\r\n *<\/span>\r\n <\/label>\r\n

\t\t

\t\t\t\n\t\t\t\t\t Yes<\/label><\/div>\n\t\t

\t\t\t\n\t\t\t\t\t No<\/label><\/div>\n<\/div>\r\n \r\n \r\n<\/div>\n

\r\n If \u2018No\u2019, nature or cargo\r\n <\/span>\r\n <\/label>\r\n

<\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_386_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ntri4\" class=\"frm_primary_label\">Last cargo\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ntri4\" name=\"item_meta[386]\" value=\"\"  data-reqmsg=\"Last cargo cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last cargo is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_387_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_sswxy\" class=\"frm_primary_label\">Agent Contact Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_sswxy\" name=\"item_meta[387]\" value=\"\"  data-reqmsg=\"Agent Contact Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Agent Contact Name is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_388_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_fgo63\" class=\"frm_primary_label\">Agent Contact Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_fgo63\" name=\"item_meta[388]\" value=\"\"  data-reqmsg=\"Agent Contact Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Agent Contact Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"99999999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_389_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_zbzuf\" class=\"frm_primary_label\">Launch Name and Location\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[389]\" id=\"field_zbzuf\" rows=\"5\"  data-reqmsg=\"Launch Name and Location cannot be blank.\" aria-required=\"true\" data-invmsg=\"Launch Name and Location is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_390_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_xut6r\" class=\"frm_primary_label\">Launch mobile number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_xut6r\" name=\"item_meta[390]\" value=\"\"  data-reqmsg=\"Launch mobile number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Launch mobile number is invalid\" aria-invalid=\"false\"   min=\"8\" max=\"99999999999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_420_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">Additional information<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_407_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_tamlj\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_tamlj\" name=\"item_meta[407]\" value=\"\"  data-reqmsg=\"Email Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_527_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ee4h2\" class=\"frm_primary_label\">Single Line Text\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ee4h2\" name=\"item_meta[527]\" value=\"Please send a copy of the last certificate\"  data-frmval=\"Please send a copy of the last certificate\" data-invmsg=\"Single Line Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_528_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_d3fq4\" class=\"frm_primary_label\">File Upload\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_d3fq4\" name=\"item_meta[528]\" value=\"\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_421_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_owndk\" id=\"field_owndk_label\" class=\"frm_primary_label\">End Section\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_owndk\" name=\"item_meta[421]\" value=\"\"  data-invmsg=\"End Section is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_422_container\" class=\"frm_form_field  frm_html_container form-field\"><b>Applicant will be required to sign application form prior to document being issued by the Agency.<\/b><\/div>\n<div id=\"frm_field_391_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">I certify that the information contained in this Application is true to the best of my knowledge and belief.\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-0\">\t\t\t<label  for=\"field_lrsbv-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_lrsbv-0\" value=\"Yes\"  data-reqmsg=\"I certify that the information contained in this Application is true to the best of my knowledge and belief. cannot be blank.\" data-invmsg=\"I certify that the information contained in this Application is true to the best of my knowledge and belief. is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Yes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_546_container\" class=\"frm_form_field  frm_html_container form-field\">* obligatory fields<\/div>\n<div id=\"frm_field_596_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_6e6mi\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_6e6mi\" name=\"item_meta[596]\" value=\"\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2600","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"Chris Segovia","author_link":"https:\/\/www.environmental-agency.gi\/author\/csegovia\/"},"rttpg_comment":0,"rttpg_category":null,"rttpg_excerpt":null,"_links":{"self":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2600","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/comments?post=2600"}],"version-history":[{"count":1,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2600\/revisions"}],"predecessor-version":[{"id":2602,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2600\/revisions\/2602"}],"wp:attachment":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/media?parent=2600"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}