Date of Arrival

Vaccination List
08 Nov 2016
Name of ship Port of arrival

GASCHEM HAMBURG La Union

Nationality of ship Last port

LIBERIA Corpus Christi, TX, U. S. A.

No. Name Rank Issued date of Expiry date of
YELLOW FEVER YELLOW FEVER

1 KUNZE, THOMAS Master 09/11/2015 life of person vaccinated

2 ROEHL, JENS Chief. Off. 13/06/2007 life of person vaccinated

3 MATZEIT, LEIF 2nd Off. 08/01/2011 life of person vaccinated

4 KREYENSCHMIDT, NIKLAS 3rd Off. 17/03/2011 life of person vaccinated

5 JANTHUR, ANDRE Chief Eng. 05/08/2010 life of person vaccinated

6 FLUDER, MARCIN ANDRZEJ 2nd Eng. 18/02/2008 life of person vaccinated

7 POHINO, ARCHIE GABIJAN 3th Eng. 19/06/2015 life of person vaccinated

8 BELYALETDINOV, RAVIL ABDULVEROVICH El.-Techn. Off. 05/09/2009 life of person vaccinated

9 VILLOSO, JAYSON DELA CRUZ Pumpman/Gas 05/11/2008 life of person vaccinated

10 ELEGIO, ULRICO CALUNGSOD Bosun 17/10/2010 life of person vaccinated

11 DAIGDIGAN, ZALDY JUANILLO AB1 16/06/2010 life of person vaccinated

12 GIMENO, GIMAR MARMOLEJO AB2 04/01/2016 life of person vaccinated

13 NAVARRO, GARRY LEO VITUDIO OS1 13/11/2014 life of person vaccinated

14 LILA, DARYLE JOHN MELITANTE OS2 10/10/2011 life of person vaccinated

15 LIWANAG, HERMIE BOY LEGACION Oiler 15/06/2012 life of person vaccinated

16 DAGUMAN, EUGENE SACUROM Wiper 11/03/2013 life of person vaccinated

17 PONTILLO, VENANCIO JR. SALUDO Cook 23/10/2012 life of person vaccinated

18 GALVEZ, JEREMY PANSACALA Messman 16/08/2013 life of person vaccinated

19 SYKULAK, ADAM LESZEK Electr. Cadet 20/08/2015 life of person vaccinated

20 KOZAK, JACEK ADAM Fitter 07/07/2009 life of person vaccinated

21 KLIX, MARVIN Naut.Off.Ass. 22/09/2015 life of person vaccinated

Capt. Thomas Kunze

Master
 NIL List

Page No.
X Arrival Departure 1 of 1
Name of ship Port of arrival Date of arrival/departure

GASCHEM HAMBURG La Union, El Salvador 08 Nov 2016

Nationality of ship Port arrived from

LIBERIA Corpus Christi, TX, U. S. A.

PASSENGERS - NIL

STOWAWAYS - NIL

ARMS - NIL

AMMUNITION - NIL

ANIMALS - NIL

DANGEROUS DRUGS / OPIUMS / NARCOTICS - NIL

MAIL / PARCELS - NIL

RADIO ACTIVE MATERIALS - NIL

* * * * * * * * * * * * * * * NOTHING FOLLOWS * * * * * * * * * * * * * * *

Capt. Thomas Kunze

MASTER
 MARITIME DECLARATION OF HEALTH
To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports.

Submitted at the port of

La Union date
08 Nov 2016

Name of ship or inland navigation vessel GASCHEM HAMBURG Registration / IMO No 9471018

Arriving from
Corpus Christi, TX, U. S. A. sailing to
Corpus Christi, TX, U. S. A.

(Nationality)/(Flag of vessel) LIBERIA Master's name Capt. Thomas Kunze

Gross tonnage (ship)

22,977 Tonnage (inland navigation vessel)

Valid Ship Sanitation Control Exemption / Control Certificate carried on board?

yes X no Issued at Balboa, Panama date 12 Jun 2016

Re-inspection required ? yes X no

Has ship/vessel visited an affected area identified by the World Health Organization?

yes no X Port and date of visit

List ports of call from commencement of voyage with dates of depature, or within past thirty days, whichever is shorter:
see attached Port Of Call List

Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined ship/vessel since international voyage began or within
past thirty days, whichever is shorter, including all ports/countries visited in this period (add additional names to the attached schedule):
(1) Name joined from: (1) (6) (6)

(2) Name joined from: (2) (7) (7)

(3) Name joined from: (3) (8) (8)

(4) Name joined from: (4) (9) (9)

(5) Name joined from: (5) (10) (10)

Number of crew members on board

21
Number of passengers on board
NIL
Health questions

(1)
If any person died on board during the voyage otherwise than as a result of accident? yes no
X

if yes, state particulars in attached schedule. Total no.of deaths

NIL
(2)
Is there on board or has there been during the international voyage any case of dissease which you suspect to be of an infectious nature?

yes no
X If yes, state particulars in attached schedule.
(3)
Has the total number of ill passengers during the voyage been greater than normal/expected?

yes no
X how many ill persons?
NIL
Is there any ill person on board now?
(4)
yes no X If yes, state particulars in attached schedule.

(5) Was a medical pactitioner consulted?

yes no X If yes, state particulars of medical treatment or advise provided in attached schedule.

(6)
If you aware of any condition on board which may lead to infection or spread of disease?

yes no
X If yes, state particulars in attached schedule.

(7)
If any sanitary measure (e.g. guarantine, isolation, disinfection or decontamination) been applied on board?

yes no
X if yes, specify type, place and date
N/A
(8) X
Have any stowaways been found on board? yes no

If yes, where did they join the ship (If known)?

(9)
Is there a sick animal or pet on board? yes no
X

Not : In the absence of a surgeon,the master should regard the following symptoms as grounds for suspecting the existence of a disease of an infectious nature:
(a) fever, persisting for several days or accompanied by (i) prostration; (ii) decreased consciousness; (iii) glandular swelling;(iv) jaundice; (v) cough or shortness of breath; (vi) unusual bleeding; (vii) paralysis.

(b) with or without fever: (i) any acute skin rash or eruption; (ii) severe vomiting (other than sea sickness); (iii) severe diarrhoea; or (iv) recurrent convulsions.

I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule) are true and correct to the best of my knowledge and belief.

08 Nov 2016 Capt. Thomas Kunze N/A

Date Signed Countersigned
Master Ship's Surgeon (if carried)
 ATTACHMENT OF MARITIME DECLARATION OF HEALTH

Drugs
Reported to a
Class or Port, date joined Date of onset Disposal of case medicines or
Name Age Sex Nationality Nature of illness port medical Comments
rating ship/vessel of symptoms (*) other treatment
officer?
given to patient

NIL
(*) State: (1) Whether the person recovered, is still ill or died ?
(2) Whether the person is still on board,was evacuated (including the name of the port or airport), or was buried at sea. ?
 PORTS OF CALL - LIST

Name of ship Port of arrival Date of arrival

GASCHEM HAMBURG La Union 08 Nov 2016

Nationality of ship Port arrived from

LIBERIA Corpus Christi, TX, U. S. A.

No. Voyage Port name, country Date of arrival Date of departure Activities sec. level sec. level
Port Ship

12/16 Panama Canal / Cristobal, Panama 03/11/2016 06/11/2016 Transit 1 1

Last 12/16 Corpus Christi, TX, U.S.A. 28/10/2016 29/10/2016 Loading 1 1

11/16 Panama Canal / Balboa, Panama 22/10/2016 23/10/2016 Bunkers, Transit 1 1

2nd Last 11/16 La Union, El Salvador 15/10/2016 20/10/2016 Discharging 1 1

11/16 Panama Canal / Cristobal, Panama 09/10/2016 13/10/2016 Transit 1 1

3rd Last 11/16 Corpus Christi, TX, U.S.A. 02/10/2016 05/10/2016 Loading 1 1

10/16 Panama Canal / Balboa, Panama 26/09/2016 28/09/2016 Transit, Bunkers 1 1

4th Last 10/16 La Union, El Salvador 20/09/2016 24/09/2016 Discharging 1 1

10/16 Panama Canal / Cristobal, Panama 14/09/2016 17/09/2016 Transit 1 1

5th Last 10/16 Corpus Christi, TX, U.S.A. 06/09/2016 09/09/2016 Loading 1 1

10/16 Panama Canal / Balboa, Panama 31/08/2016 01/09/2016 Bunkers, Transit 1 1

6th Last 09/16 La Union, El Salvador 21/08/2016 28/08/2016 Discharging 1 1

09/16 Panama Canal / Cristobal, Panama 18/08/2016 19/08/2016 Transit 1 1

7th Last 09/16 Corpus Christi, TX, U.S.A. 10/08/2016 13/08/2016 Loading 1 1

09/16 Panama Canal / Balboa, Panama 05/08/2016 05/08/2016 Transit, Bunkers 1 1

8th Last 08/16 La Union, El Salvador 26/07/2016 02/08/2016 Discharging 1 1

08/16 Panama Canal / Cristobal, Panama 22/07/2016 24/07/2016 Transit only 1 1

9th Last 07/16 Corpus Christi, TX, U.S.A. 14/07/2016 18/07/2016 Loading 1 1

07/16 Panama Canal / Balboa, Panama 08/07/2016 10/07/2016 Bunkers, Transit 1 1

10th Last 07/16 La Union, El Salvador 28/06/2016 06/07/2016 Discharging 1 1

Capt. Thomas Kunze

Master