文件号码Document number

确认机构Validating Authority

1.名称Name

地址Address

电话Tel.

传真Fax

2.渔船船名Fishing Vessel Name

船旗、船籍港和注册号Flag - Home Port and Registration Number

呼号Call Sign

IMO/劳埃德号(如有)IMO/Lloyd’s Number (if issued)

捕捞许可号-有效期到Fishing licence No.-Valid to

Inmarsat号、传真、电话、电邮地址（如有）Inmarsat No. Telefax No. Telephone No. E-mail address(if issued)

3.产品描述Description of Product

批准的船上加工方式Type of processing authorised on board:

4.适用的养护和管理措施引用 References of applicable conservation and management measures

物种Species

产品代码Product code

捕捞区域和时间Catch area(s) and dates

活体量预估Estimated live weight (kg)

预计上岸量Estimated weight to be landed (kg)

上岸量核实（酌情） Verified Weight Landed (kg)where appropriate

5.渔船船长姓名-签字-盖章Name of master of fishing vessel - Signature - Seal:

6.海上转运声明Declaration of Transhipment at Sea

渔船船长姓名Name of Master of Fishing vessel

签字和日期Signature and Date

转运日期/区域/位置Transhipmen Date/Area/Position

预计重量Estimated weight (kg)

接收船船长Master of Receiving Vessel

签字Signature

船名Vessel Name

呼号Call Sign

IMO/劳埃德号（如有）IMO/Lloyds Number(if issued)

7.在港口区域的转运许可Transhipment authorisation within a Port Area:

姓名Name

机构Authority

签字Signature

地址Address

电话Tel.

卸货港Port of Landing

卸货日期Date of Landing

盖章Seal (Stamp)

8.出口商姓名和地址Name and address of Exporter

签字Signature

日期Date

盖章Seal

9.船旗国主管机构确认Flag State Authority Validation:

姓名/职务Name/Title

签字Signature

日期Date

盖章Seal (Stamp)

10．运输细节（见附录1）Transport details : See Appendix I

11．欧盟进口商声明EU Importer Declaration:

进口商姓名和地址Name and address of Importer

签字Signature

日期Date

盖章Seal

产品CN号码Product CN code

第1005/2008号条例（EC）第14条1和2款文件Documents under Articles 14(1),(2) of Regulation (EC) No 1005/2008

引述References

12.进口控制：机构Import control: Authority

地点Place

允许进口Importation authorised*

暂停进口Importation　suspended*

要求核查-日期Verification requested - date

海关报关(如有) Customs declaration (if issued)

号码number

日期Date

地点Place