Bahamas Customs Clearance Forms

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clearance: vessel name: bahamas customs clearance inbound outbound .at gross tonnage: .ft./m sighting only registration address: rotation ref:
NAME

CLASS OF RATING

SEX

NATIONALITY

DATE OF EMBARKING

NATURE OF ILNESS

DATE OF OFF-SET

MARITIME DECLARATION OF HEALTH APPENDIX 5 (CONTINUED) SCHEDULE TO THE DECLARATION PARTICULARS OF EVERY CASE OF ILLNESS OR DEATH OCCURRING ON BOARD AGE

*State whether recovered:_______ Still Ill:______ Died: ______

RESULT OF ILNESS

DISPOSAL OF CASE

______________________________ MASTER’S SIGNATURE

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