CREW LIST
                                                                                                                                                           (IMO FAL Form 5)

                                                                                                                                                 Arrival                         Departure                           Page Number
                                                                  1.1 Name of ship                                                           1.2 IMO number                                  1.3 Call sign                       1.4 Voyage number
                                                                  2. Port of arrival/departure                                               3. Date of arrival/departure                    4. Flag State of ship               5. Last port of call




                                              (VKBL. 2021 S. 9)
                                                                  6. No.     7. Family       8. Given        9. Rank or      10. Nationality 11. Date of       12. Place of   13. Gender     14. Nature        15. Number        16. Issuing        17. Expiry date
                                                                                name            names           rating                           birth             birth                         of identity       of identity       State of           of identity
                                                                                                                                                                                                                                                                      VkBl. Amtlicher Teil




                                                                                                                                                                                                 document          document          identity           document
                                                                                                                                                                                                                                     document
                                                                                                                                                                                                                                                                      11




Auszug aus dem Verkehrsblatt Amtlicher Teil
                                                                  18. Date and signature by master, authorized agent or officer
                                                                                                                                                                                                                                                                      Heft 1 – 2021