ISPS Forms1

AMBUJA CEMENTS LTD.
SHIP SECURITY PLAN

Page: 1 of 1
APPENDIX 5
SECURITY INCIDENT REPORT FORM
Security Incident Report Form
Details Required Details Recorded
Date
Name of Ship
Flag Capt TPS Bakshi
Master
Location of Ship (Lat & Long at sea, at
anchor, in port)
Port Facility Security Officer
Reporting Officer
Ship Operations (loading/discharging
cargo, bunkering, awaiting pilot etc.)
Date, time and place of incident
Brief Description of incident
Number of those involved crew, others.

Action Taken
Subsequent Action
Reported to : (as required)
CSO
Company
Local Authorities
What measures are recommended to
prevent recurrence of a similar event
SSO / DATE
MANAGEMENT COMMENT:
SIGNATURE:
CSO / DATE JT. PRESIDENT/ DATE
Security incident means any suspicious act or circumstance threatening the security of a ship,
including a mobile offshore drilling unit and a high-speed craft, or of a port facility or of any
ship/port interface or any ship to ship activity.
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN
Page: 1 of 3
APPENDIX 6 A
DECLARATION OF SECURITY FORM
FORM OF A DECLARATION OF SECURITY BETWEEN A SHIP AND A

PORT FACILITY*
Name of Ship
Port of Registry
IMO No.
Name of Port Facility
This Declaration of Security is valid from until
for the following activities.
(list the activities with relevant details)
Under the following security levels
Security level(s) for the ship

Security level(s) for the port facility
The port facility and ship agree to the following security measures and
responsibilities to ensure compliance with the requirements of Part A of the
International Code for the Security of Ships and of Port Facilities.
*This form of Declaration of Security is for use between a ship and a port
facility. If the Declaration of Security is to cover two ships, this model
should be appropriately modified.
Page: 2 of 3
The affixing of the initials of the Master

(SSO) or PFSO under these columns
indicates that the activity will be done, in
accordance with the relevant approved
plan, by
Activity The port facility The ship
Ensuring the performance of all
security duties
Monitoring restricted areas to
ensure that only authorized
personnel have access
Controlling access to the port
facility
Controlling access to the ship
Monitoring of the port facility,
including berthing areas and areas
surrounding the ship
Monitoring of the ship, including
berthing areas and areas
Handling of cargo
Delivery of ship’s stores
Handling unaccompanied baggage
Controlling the embarkation of
persons and their effects
Ensuring that security
communication is readily available
between the ship and the port
facility
The signatories of this agreement certify that security measures and

arrangements for both the port facility and the ship vide Part A of the Code will
be implemented in accordance with the provisions already stipulated in their
approval plan or the specific arrangements agreed to and set out in the attached
annex.
Dated at on the day of the year Two Thousand & .

Page: 3 of 3
Signed for and on behalf of

The port facility The ship
(Signature of (Signature of Master or

Port Facility Security Officer) Ship Security Officer)
Name and title of person who signed
Name: Name:
Title: Title:
Contact details
(to be completed as appropriate)
(indicate the telephone numbers or the radio channels
or frequencies to be used)
For the Port Facility: For the Ship:
Port Facility Master
Port Facility Security Officer Ship Security Officer
Company
Company Security Officer

Page: 1 of 3
APPENDIX 6 B
DECLARATION OF SECURITY FORM
FORM OF A DECLARATION OF SECURITY BETWEEN OWN SHIP AND

OTHER SHIP
Name of Own Ship
Port of Registry
IMO No.
Name of Other Ship
Port of Registry
IMO No.
This Declaration of Security is valid from until
for the following activities.
(list the activities with relevant details)
Under the following security levels
Security level(s) for own ship

Security level(s) for the other ship
The other ship and own ship agrees to the following security measures and
responsibilities to ensure compliance with the requirements of Part A of the
International Code for the Security of Ships and of Port Facilities.
Page: 2 of 3
The affixing of the initials of the SSO

of own ship and other ship under these
columns indicates that the activity will
be done, in accordance with the
relevant approved plan, by
Activity Own Ship Other Ship
Ensuring the performance of all
security duties
Monitoring restricted areas to ensure
that only authorized personnel have
access
Controlling access to the ship
Monitoring of the port facility/
anchorage including berthing areas
/anchorage areas and areas
Monitoring of the ship, including
berthing/anchorage areas & areas
Handling of cargo
Delivery of ship’s stores
Handling unaccompanied baggage
Controlling the embarkation of
persons and their effects
Ensuring that security communication
is readily available between own ship
& other ship.
The signatories of this agreement certify that security measures and

arrangements for both the own ship and the other ship vide Part A of the Code
will be implemented in accordance with the provisions already stipulated in their
approval plan or the specific arrangements agreed to and set out in the attached
annex.
Dated at on the day of the year Two Thousand & .

Page: 3 of 3
Signed for and on behalf of

Own ship Other Ship
(Signature of Master or (Signature of Master or

Ship Security Officer of Ship Security Officer of
Own ship) Other Ship)
Name and title of person who signed
Name: Name:
Title: Title:
Contact details
(to be completed as appropriate)
(indicate the telephone numbers or the radio channels
or frequencies to be used)
For Own Ship: For Other Ship:
MASTER MASTER
SHIP SECURITY OFFICER SHIP SECURITY OFFICER
COMPANY COMPANY
COMPANY SECURITY OFFICER COMPANY SECURITY OFFICER

Page: 1 of 2
APPENDIX 7
DRILL & EXERCISES LOG SHEET FORMAT
SHIP’S NAME AMBUJA ROHINI DATE 16.05.2012
DRILL/EXERCISE
PLACE / LOCATION
VESSEL DETAILS DRAUGHT F A
CARGO BALLAST BUNKERS
COURSE SPEED
WEATHER CONDITION
MINUTES OF DRILL/EXERCISE:
Page: 2 of 2
APPENDIX 7
DRILL & EXERCISES LOG SHEET FORMAT
AUTHORIES INFORMED:CSO, PFSO,DG Com.Centre, Coast Guard, Jawahar Port Control,

BCT Panvel.
REVIEW COMMENTS / LESSONS LEARNT:
DEBRIEFING OF CREW:
MASTER (SSO)
NAME: CAPT.
IN ACCORDANCE WITH ISPS A/9.8.1, THE

CONTENTS OF APPENDIX 8, 9, 10, 11 & 12
ARE CONSIDERED AS CONFIDENTIAL
INFORMATION, AND CANNOT BE SUBJECT
TO INSPECTION UNLESS OTHERWISE
AGREED BY THE CONTRACTING
GOVERNMENTS CONCERNED.
Page: 1 of 6
APPENDIX 9
CONTINGENCY PROCEDURES
Contingency Procedure
The management of security onboard ships is primarily concerned with deterrence and
prevention. Contingency plans are an essential part of the preparation for such events.
In addition, contingency plans make a very useful basis for onboard training, drills and
exercises. The following contingencies are covered in this Appendix:
1. Bomb Threat
2. Pirate Attack
3. Unauthorised Boarding / Hijacking
4. Stowaways
5. Smuggling of Illegal Contraband
Page: 2 of 6
1. Bomb Threat
THREAT ACTIONS
Bomb Threat If a bomb threat is received, it is the responsibility of the Master
(SSO) to decide with the information he has been given and in
conjunction with advice from the relevant authorities, whether threat
is legitimate.
Emergency alarm shall be raised, crew mustered and security briefing
carried out. Security measures required for Security Level 3 shall be
implemented. Complete search of the vessel shall be carried out.
A bomb can be disguised in many ways. It can be placed or delivered in a number of

ways:
1. In the ship’s stores.
2. Carried onboard by shore workers in port or by contractor’s personnel.
3. Placed under the hull by divers.
If there is a bomb threat, Master (SSO) must ask the following questions, noting the
time of call.
When is the bomb going to explode?

Where is the bomb and what does it look like?
What kind of bomb is it?
What will cause it to explode?
Did you place the bomb and Why?
Where are you calling from?
What is your name and address?
Bomb Threat Check List
Details Required Details Received

Details of Call
Time and Date of Call
Name of ships personnel who took the
call?
Name of the caller and organisation if
given.
Time the Bomb is set to explode
Is there more than one bomb?
Location of the bomb
What does it look like?
What type of bomb is it?
Why did you plant the bomb
Note down the exact words of the caller.
Voice of the caller, did he have an
accent? Was he distressed?
Nature and extent of threat with respect
to vessel, crew, cargo and environment.
Who has been notified? When?
CSO
Port Authorities
DG Comm Centre
Coast Guard
Follow up Actions
Page: 3 of 6
2. Pirate Attack
Following actions as applicable shall be taken:
a) Sound the emergency alarm.

b) Master (SSO) to muster crew and carry out security briefing.
c) All security measures required for Security Level 3 shall be implemented.
d) Crew “stand-by”. Prepare to defend the vessel by barricading all access routes to
the vessel.
e) Keep the radio station “stand-by” – with current and updated position available.
f) Establish VHF communication with signal stations, coast radio stations and other
vessels in surrounding waters.
g) Request assistance from local Port Authority, Police, Coast Guard and Navy.
h) If possible, speed up and carry out evasive manoeuvre.
i) Water on deck – make fire hoses ready in order to avoid pirates from boarding.
j) Fire parachute light in the direction of the attacking craft.
k) Use the searchlights to illuminate and possibly blind the attacking craft.
l) Switch on the hull lights and outside accommodation lights.
m) Mark time and position of the attack.
During the Actual Attack :
a) Avoid violence.
b) Try to ward off pirates, or delay entry by fire hosing, barricading or similar actions.
c) Barricade the whole crew on the bridge and/or in the engine room. Try to bring
portable VHF.
d) Establish communication between the bridge and the engine room.
e) Remain barricaded until the danger is over. Notify Company Security Officer, DG
Comm Centre, Coast Guard and Port authorities about the attack as soon as
possible.
Page: 4 of 6
3. Unauthorised Boarding / Hijacking

Guidance for Master (SSO) in the event of a Unauthorised Boarding:
 Sound the emergency alarm.
 Master (SSO) to muster crew and carry out security briefing.
 All security measures required for Security Level 3 shall be implemented.
 Keep calm and advise all others to do the same.
 Do not try to resist armed boarders.
 Ensure the safety of the ship in accordance with maritime practice.
 Broadcast a distress message.
 Offer reasonable co-operation. Abuse or aggression should not be returned.
 Intruders are unlikely to understand how a particular ship works.
 Try and establish what intruders want and where they are from.
 Notify Company Security Officer, DG Comm Centre, Coast Guard and Port authorities
as soon as possible.
Without suggesting what they may be, seek to establish the hijackers demands and
what deadlines have been set for meeting them.
Assume that the incident will be prolonged. The longer incidents drag on, the more
likely they are to end without injury to the crew.
Recognise that crew may feel isolated during the incident, as they will be unaware of
steps being taken by the company and/or government authorities on their behalf. This
can lead to antagonism against the authorities and sympathy for the hijackers. Every
effort will be made to end the incident with the utmost emphasis on the preservation of
life and personal safety of all innocent parties involved.
Understand that a reasonable rapport between crew and hijackers is likely to reduce
the chances of the hijackers acting violently against the crew.
Be aware that at some stage in the incident, a confrontation between the hijackers and
the outside authorities may occur.
Encourage the establishment of a secure, direct negotiation channel with the

authorities.
Avoid crew members becoming directly involved in negotiations. If crew members are
forced to take part they should simply relate the dialogue back and forth.
Wherever and whenever possible, the hijackers should be encouraged to surrender

peacefully and should be discouraged from ill treating the crew.
Be aware also that military action may, in the last resort, be taken in order to save life
and recapture the vessel.
Before this confrontation, an opportunity may arise or may be created to pass

information about the hijackers, such as:
 Their number, Descriptions & Sex
 How they are armed
 How they deploy themselves
 How they communicate with each other, their cause & Nationality
 Language(s) spoken and understood
 Their standard of competence and their level of vigilance
 Whether any of the hostages have been separately identified with regards to
nationality, religion or occupation. For example, ex-military.
Page: 5 of 6
4. Stowaways
Guidance for Master (SSO) in the event of stowaways on board:

d) Complete search of the vessel shall be carried out to identify number of stowaways.
e) Determine the port of embarkation of the stowaways.
f) Make every effort to establish the identity and the nationality of the stowaways.
g) Prepare a statement containing all information relevant to the stowaways for the
appropriate authorities.
h) Notify Company Security Officer, DG Comm Centre, Coast Guard and Port authorities
i) Do not depart from the planned voyage to seek disembarkation of stowaways unless
repatriation has been arranged and permission given for disembarkation.
j) Ensure that the stowaways are presented to the appropriate authorities at the next
port of call.
k) Take following measures to ensure the security, general health, welfare and safety
of the stowaways until disembarkation:
 Stowaways should be treated humanly while having due regard for the safety of
others on board.
 A thorough search of the stowaways’ possessions should be conducted and any
item that could pose a threat to the ships crew removed.
 Stowaways should always be kept in a secured part of the vessel such as a cabin
or storeroom, where the doors can be locked and all windows secured to reduce
the risk of escape.
 Regular patrolling shall be carried out, stowaways should not be allowed to
escape from the vessel.
 To reduce the risk of stowaways, receiving help to escape from crew members
that they have befriended, contact with the crew to be kept to a minimum.
 Mental and physical health of the stowaways should be monitored. Risk of
infectious diseases should also be considered and suitable precautions taken.
 The stowaways should always be provided with food and water.
 The stowaways should not be allowed to work on board as this may result in
greater claims on the ship owner.
The stowaways shall be disembarked / repatriated after permission is granted by

appropriate authorities in consultation with CSO.
Page: 6 of 6
5. Smuggling of Illegal Contraband
Guidance for Master (SSO) in the event of smuggling of illegal contraband on board:

d) Carry out complete search of the vessel to identify contraband items.
e) Master (SSO) shall prepare a list of all contraband items found on board.
f) All contraband items found on board shall be locked in a store room and the key
held with Master (SSO).
g) Notify Company Security Officer, DG Comm Centre, Coast Guard and Port authorities
h) CSO shall inform Customs and Police about the discovery of contraband items on the
ship.
i) Master (SSO) shall make an effort to identify if crew members are involved in
smuggling of illegal contraband. This information shall be passed on to CSO for
further action.
j) If the smuggling of illegal contraband includes drugs, the matter must be
immediately reported to CSO, who in turn will inform appropriate authorities.
k) All contraband items found on board shall be handed over to Custom officials at the
next port of call in consultation with CSO.
Page: 1 of 2
APPENDIX 12
SECURITY EQUIPMENT – INSPECTION, TESTING, CALIBRATION &

MAINTENANCE
DETAILS OF SECURITY EQUIPMENT
1) Deck lighting 14 nos. (as shown in Deck Light Arrangement

Plan)
2) High Beam Flash Lights 2 nos. (kept on bridge)
3) Whistles 5 nos. (kept on bridge)
4) Dog Leg Mirrors 2 nos. (kept on bridge)
5) Cable ties 100 nos. (kept on bridge)
6) Walkie Talkies 3 nos.
7) Different Colour Passes 20 each Green, Orange & Yellow colour passes
GATE PASSES
Different colour of gate passes to be issued by the company for segregation of different
category of persons. Master (SSO) will authorise issue of a Yellow or an Orange colour
pass.
Ambuja Employee Company Photo Identity Card Individual

Ship Staff Photo Identity Card issued by Master Individual
Internal Workshop Team Green Colour Gate Pass without Photo Individual
External Workshop Team Yellow Colour Gate Pass without Photo Security Guard
Guests / Visitors Orange Colour Visitors Pass without Security Guard
Photo
When vessel is calling at dedicated port i.e. Muldwarka, Ulwa and Panvel, Master will
instruct security to issue a Yellow or an Orange colour pass as applicable. Master will
issue photo Gate Pass to all ship staff as per specimen provided in Appendix 22.
Procedures for maintenance, calibration and testing of security equipment
Visual inspection of security equipment provided on board is to be carried out by

Master (SSO) every month. All security equipment is to be mustered, visually inspected
and condition recorded in the format attached in Appendix 12. A copy of this format is
to be filled up, signed by the Master every month and filed in File No. 10. If any
deficiency is found in the security equipment, the same shall be recorded and brought
to the notice of the CSO immediately.
Page: 2 of 2
APPENDIX 12
SECURITY EQUIPMENT – INSPECTION, TESTING, CALIBRATION &

MAINTENANCE
DATE OF INSPECTION: _____________
S. N. EQUIPMENT QUANTITY REMARKS
1 Deck lighting 14 nos.
2 High Beam torch* 2 nos.
3 Whistle 5 nos.
4 Dog leg mirror 2 nos.
5 Cable tie 100 nos.
6 Walkie Talkie 3 nos.
7 Different Colour 20 nos.

Passes – Green, each
Orange & Yellow
* High Beam Torch is to be discharged completely and then charged

every Month and date of discharge / charge is to be mentioned in the
remarks column.
MASTER (SSO)
Page: 1 of 1
APPENDIX 13
RECORD OF CHANGES
Prep. By:
Revision:
SHIP SECURITY PLAN APPROVAL
Reviewed Page 1 of 1
PAGE
Date: By:
Amendment No: Section/s revised:
Date of Revision:
ISSUED BY CSO: SIGNATURE:
AMBUJA CEMENTS LTD. NAME:
SEAL:
APPROVED BY:
DIRECTORATE GENERAL OF SIGNATURE:

SHIPPING
MUMBAI.
NAME:
Note: The Ship Security Plan complies

with SOLAS Ch XI-2, Reg. 4 and ISPS
Code. In the development of the SSP in SEAL:
accordance with ISPS Code Part A/9.4,
the provisions of ISPS Code Part B/8.1 to
13.8 have been duly taken into account
and applied as appropriate for the ship.
DISTRIBUTION OF MANUAL:
DG Shipping (Electronic form)
Ships Name
M/s. Ambuja Cements Ltd.
Ships Name:
Page: 1 of 6
APPENDIX 14
GUIDELINES FOR CARRYING OUT SEARCH
When a partial or complete search of the vessel is to be carried out, Master (SSO)
shall determine whether the search is to be carried out for Improvised Explosive
Device (IED) or a person and accordingly brief crew members.
When the threat is imminent and vessel has to be evacuated immediately, partial
search of evacuation route shall be carried out for safe passage of crew members
upto exit point from the vessel.
When the threat is not so imminent, partial search of evacuation route and other
important locations like bridge, engine room and accommodation shall be carried
out first, thereafter other areas can be searched.
In order to carry out the search in a planned manner, format of search teams
and search area checklist is provided. It is recommended that when search is
initiated, Team 1 searches Area 1, Team 2 searches Area 2 and Team 3 searches
Area 3. Each team should have a detailed checklist of area allocated for search.
After completing search of a compartment, the team should secure the
compartment, if possible or tick (√) it with chalk and report to SSO.
Compartments which are locked or found secured with cable tie need not be
searched. If certain areas are not applicable to the vessel, ‘N. A.’ should be
written. If required, additional areas may be added in the search areas checklist.
The search should be conducted according to a specific plan, which should be

explained to each team before starting the search and must be carefully
monitored to ensure that a complete search has been carried out.
Page: 2 of 6
APPENDIX 14
SEARCH TEAMS
Ship Name: M. V. AMBUJA ROHINI
Chief Co-ordinator: Master (SSO)
Assisted by: NWKO 2 / JUNIOR OFFICER
TEAM 1 TEAM 2 TEAM 3

CHIEF OFFICER CHIEF ENGINEER NWKO 1
SEAMAN 1 2ND ENGINEER SEAMAN 3
SEAMAN 2 3RD ENGINEER COOK
1 E/R RATING
NOTE:
1) TEAM FINISHING ITS JOB IS TO ASSIST ANOTHER TEAM AS

DIRECTED BY THE MASTER (SSO).
2) EACH TEAM SHOULD HAVE A DETAILED CHECKLIST OF SPACES TO

BE SEARCHED IN ALLOCATED SEARCH AREAS.
Page: 3 of 6
APPENDIX 14
ALLOCATION OF SEARCH AREAS
TEAM SEARCH AREAS

NO. STAGE 1 STAGE 2
1. PASSAGES WITHIN CA OPEN AREAS OF MAIN DECK
2. WHEELHOUSE
1 3. RESCUE BOAT OPEN AREAS ON FORECASTLE
DECK
BOSUN STORE
1. ENGINE ROOM
2. EMERGENCY ESCAPE ROUTE
3.STEERING GEAR ROOM
2
4.ELECTRICAL PANELS /
DISTRIBUTION BOARDS
WITHIN ER AND CA
1. GALLEY AND MESS ROOMS,
PROVISION STORE, FREEZER
ROOM
3
2. COMMON USE TOILET AND
SHOWER BLOCKS WITHIN CA
NOTES:
1. AT END OF STAGE 1, ALL CREW ARE TO SEARCH THEIR OWN CABINS.
2. CA: CREW ACCOMMODATION

Page: 4 of 6
APPENDIX 14
SEARCH AREAS CHECKLIST FOR TEAM 1

This checklist is to be completed by each search team leader during
search and consolidated by SSO. The spaces below once checked
should be either secured if possible or marked √ with chalk.
Area 1: Main Deck Spaces
1) Hold/Tank/Void accesses 
2) Machinery rooms 
3) Fo’c’sle Space 
4) Paint Locker 
5) Forecastle Store 
6) Chain Lockers 
7) Hawse Pipes 
8) Bow Thruster Space 
9) Dust Collectors 
10) Reloaders 
11) Cargo Control Room 
12) Cargo Hold 1 
15) 
16) 
17) 
18) 
19) 
20) 
21) 
22) 
23) 
24) 
25) 
26) 
Page: 5 of 6
APPENDIX 14

Area 2: Engine Room Spaces
1. Engine Room Space 
2. Control Room

3. Store Rooms

4. Steering Gear Room

5. Engine Room Bilges/Bottom Plates

6. Workshop

7. Funnel casing/funnel top

8.

9.

10.

Page: 6 of 6
APPENDIX 14

Area 3: Accommodation
1) Bridge/radio room/battery locker/toilet 

2) Monkey Island 
3) Boat Deck 
4) Cabins 

5) Bridge Wings

6) Officers Toilet

7) Crews Toilet

8) Galley 
9) Officers Mess Room 
10) Crew Mess Room 
11) Changing Rooms 
12) Rescue Boat 
13) Deck Stores 
14) Engine Stores 
15) Laundry 

16) CO2 Room

17) A. C. Room 
18) SCBA & BA Box 

19)

20) 
21) 

22) 
23) 

24)

25) 

26)
Page: 1 of 1
APPENDIX 15
SECURITY AUDIT REPORT

Report No. Date
Opening Meeting Location
Closing Meeting Location
Ship Type Flag
Audit Team Name Signature
Lead Auditor
2nd Auditor
Summary of assessment and recommendations:
Non - conformities were identified and documented as follows:

Item No. NCR No. ISPS Clause/SSP Chapter
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
See Individual NCRs for details
Page: 1 of 1
APPENDIX 16
NON CONFORMITY REPORT
Ships name / Location : _ NCR No. : _
(to be filled in by the auditor)
NCR Initiator : Date of initiating NCR :
Reference of the Requirement (of ISPS Code or other Regulation) not complied with:
NON CONFORMITY :
Corrective / Preventive Action(s) suggested:
Signature: _ ____ Signature :___________

Initiator SSO
CORRECTIVE / PREVENTIVE ACTION APPROVED AGREED DATE
Signature: _______________________ _______________________

CSO / DATE JT. PRESIDENT / DATE
Approved corrective action completed.
Signature: _______________________ _______________________

SSO / DATE CSO / DATE
Final Distribution of closed NCR:

Page: 1 of 1
APPENDIX 17
CONTROL OF SHIP SECURITY PLAN

The Ship Security Plan is a confidential document. The handing over Master (SSO) should hand
over to the taking over Master (SSO) and a record has to be entered.
Date Name of Handing Sign Date Name of Taking Sign

over SSO over SSO
Page: 1 of 1
APPENDIX 18
RECORD OF PORTS CALLED (ATTACH DOS IF NON-COMPLIANT ISPS)
RECORD OF AT LEAST LAST 10 PORTS CALLED TO BE KEPT
Date Ports Called Security Level
The Form of a Declaration of Security between a ship and a port facility (Appendix 6) is to be
filled up as per guidelines provided in Section 3.2.5.
Page: 1 of 1
APPENDIX 19
GANGWAY REGISTER
S.N Name of Name, address Date/ Date/ Pass Name of Signature

external & Tel. No. of Time in Time No. ship
workshop external out visited
personnel, or workshop
guest / visitor personnel or
guest / visitor.
Page: 1 of 1
APPENDIX 20
KEY CONTROL REGISTER

(TO BE FILLED ONLY IN LEVEL 2 AND 3)
S.N. Date Restricted Key Time of Purpose Time of SSO/HOD

area handed handing return
compartment over to over key of key
Opening of Restricted area doors for operational cargo compartments, before loading /
unloading need not be filled, as it has to be opened for operational purpose.
Page: 1 of 2
APPENDIX 21
SHIP SECURITY PLAN ANNUAL REVIEW
SHIP: M.V. AMBUJA _ DATE: __
ISSUES RAISED CSO’s COMMENT

Page: 2 of 2
APPENDIX 21
SHIP SECURITY PLAN ANNUAL REVIEW
SHIP: M.V. AMBUJA _ DATE: _
GUIDELINES FOR CARRYING OUT SSP ANNUAL REVIEW
1. Security Level is understood by everyone on board and displayed at various

locations.
2. Security training imparted regularly understood by all.
3. Periodical drills as per schedule provided in SSP is carried out.
4. Review of Ships Security Audit Findings: Last Internal & External Security Audit.
5. Review of Security incident reports.
6. Last SSP Annual Review Report, if applicable.
7. Effectiveness of existing system, procedures, instructions, forms and checks as

mentioned in the SSP.
8. Any suggestions for improvement in the SSP.
MASTER (SSO)
NAME _
Page: 1 of 1
APPENDIX 22
SPECIMEN GATE PASS
FOR SHIP STAFF
NAME:
PASTE RANK:
PHOTO EMP. NO.
D. O. J :
SIGN OF
No - 01 MASTER (SSO) :
FOR INTERNAL WORKSHOP TEAM FOR INTERNAL WORKSHOP TEAM
Internal Workshop Pass Internal Workshop Pass
No - 01
No - 01
FOR EXTERNAL WORKSHOP TEAM FOR EXTERNAL WORKSHOP TEAM
External Workshop Pass External Workshop Pass
No - 01 No - 01
FOR GUESTS / VISITORS FOR GUESTS / VISITORS
Visitor Pass Visitor Pass
No - 01 No - 01

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AMBUJA CEMENTS LTD.

SHIP SECURITY PLAN

Number of those involved crew, others.

FORM OF A DECLARATION OF SECURITY BETWEEN A SHIP AND A

Name of Port Facility

This Declaration of Security is valid from until

for the following activities.

(list the activities with relevant details)

Under the following security levels

Security level(s) for the ship

The affixing of the initials of the Master

The signatories of this agreement certify that security measures and

Dated at on the day of the year Two Thousand & .

Signed for and on behalf of

(Signature of (Signature of Master or

Name and title of person who signed

For the Port Facility: For the Ship:

Port Facility Master

Port Facility Security Officer Ship Security Officer

Company Security Officer

DECLARATION OF SECURITY FORM

FORM OF A DECLARATION OF SECURITY BETWEEN OWN SHIP AND

Name of Own Ship

Name of Other Ship

This Declaration of Security is valid from until

for the following activities.

(list the activities with relevant details)

Under the following security levels

Security level(s) for own ship

The affixing of the initials of the SSO

The signatories of this agreement certify that security measures and

Dated at on the day of the year Two Thousand & .

Signed for and on behalf of

(Signature of Master or (Signature of Master or

Name and title of person who signed

For Own Ship: For Other Ship:

SHIP SECURITY OFFICER SHIP SECURITY OFFICER

COMPANY SECURITY OFFICER COMPANY SECURITY OFFICER

DRILL & EXERCISES LOG SHEET FORMAT

SHIP’S NAME AMBUJA ROHINI DATE 16.05.2012

VESSEL DETAILS DRAUGHT F A

CARGO BALLAST BUNKERS

DRILL & EXERCISES LOG SHEET FORMAT

AUTHORIES INFORMED:CSO, PFSO,DG Com.Centre, Coast Guard, Jawahar Port Control,

REVIEW COMMENTS / LESSONS LEARNT:

IN ACCORDANCE WITH ISPS A/9.8.1, THE

A bomb can be disguised in many ways. It can be placed or delivered in a number of

When is the bomb going to explode?

Bomb Threat Check List

Details Required Details Received

Following actions as applicable shall be taken:

a) Sound the emergency alarm.

During the Actual Attack :

3. Unauthorised Boarding / Hijacking

Encourage the establishment of a secure, direct negotiation channel with the

Wherever and whenever possible, the hijackers should be encouraged to surrender

Before this confrontation, an opportunity may arise or may be created to pass

Guidance for Master (SSO) in the event of stowaways on board:

Signature: _ Signature :_______

Signature: _ _

Signature: _ _