<p> Assistance for piracy and armed robbery Security Assessment Form </p><p>For coastguard only : Contact: KWC: Sjaco Pas Head of nautical affairs Tel./fax/email: 0223 542300 / 0223 658358 / [email protected]/[email protected] Date: Kwc dossierno: Status of request: Provisional/ definite Company name Address Areal code Town Tel./fax. E-mail Name and function of contact person for the Ministry of Defence on this voyage Ships name Flag/registration IMO-nr Call sign Type of ship (photo) Brt. Maximum transit speed (Kn) Cruising speed(Kn) Free board on high risk area passage Number and nationality of crew on board Maximum crew according to certificates Extra accommodation available Medical facilities Means of communication1 Insured value ship Insured value cargo Cargo specifications/pictures Client2 Client input: - What support is provided by the client regarding protection of cargo and ship: - Does the client has specific security demands? If yes, what kind of demands? Voyage details: - Port and expected date of departure - Port and expected date of arrival Risk area: - Type of operation in risk area 3 - ETA in risk area: - ETD of risk area: Estimated total time expected to be in the risk area </p><p>1 Incl aerial plan 2 Applicable only when there is one or only few cargo owners 3 Transit, entering port/ area’s for loading or discharge/ bunkering/docking Assistance for piracy and armed robbery Total route (mobilization, loading, voyage, discharge)</p><p>Alternatives: - Routing, Load-out, discharge location: - Feasible - Cost4 Contact nr agent in that area What is the opinion of the charterer relating VPD/PSC What is the position of your P&I, H&M and K&R regarding armed security Other relevant information: Enclose General plan, incl. cabins !</p><p>Remarks to be made by Coastguard</p><p>Feedback from departments to KWC regarding request</p><p>4 Please specify as much as possible Assistance for piracy and armed robbery</p><p>To be completed by the Company Security Officer Risk area: Date: Hazard:</p><p>Area report Incident reports graph Map of the area </p><p>Initial risk assessment</p><p>Impact level: Frequency:</p><p>1. Marine crime (ship stores) Applicable criteria5 2. Marine crime including exposure for crew o Exposure time in risk area >48 hours 3. Piracy exposure o Increase of attacks in the last quarter in 4. Severe injury / kidnap incident the risk area according to IMB reports 5. Fatalities/ multiple severe injuries / Hijack of vessel o Attacks reported last year according IMB o Vessel speed alignment o Client / cargo resulting in extra exposure</p><p>Risk: HIGH /MEDIUM LOW. Drag the black dot on the appropriate field in the matrix SECURITY RISK ASSESSMENT MATRIX</p><p>5</p><p>4</p><p>IMPACT 3</p><p>2</p><p>1</p><p>1 2 3 4 5</p><p>FREQUENCY</p><p>5 Mark if applicable: the sum of the markings is the frequency Assistance for piracy and armed robbery</p><p>Decision from Management</p><p>Control measures/ conditions6</p><p>Residual risk assessment Impact level: Frequency:</p><p>1. Marine crime (ship stores) Applicable criteria7 2. Marine crime including exposure for crew o Exposure time in risk area >48 hours 3. Piracy exposure o Increase of attacks in the last quarter in 4. Severe injury / kidnap incident the risk area according to IMB reports 5. Fatalities/ multiple severe injuries / Hijack of vessel o Attacks reported last year according IMB o Vessel speed alignment o Client / cargo resulting in extra exposure</p><p>Risk: HIGH /MEDIUM/ LOW . Drag the black dot on the appropriate field in the matrix SECURITY RISK ASSESSMENT MATRIX</p><p>5</p><p>4</p><p>IMPACT 3</p><p>2</p><p>1</p><p>1 2 3 4 5</p><p>FREQUENCY</p><p>Date: Decision:</p><p>6 For example: hardening of ship (razor wire, steel plates, flares, laser, LRAD, waterspray, etc); extra communication between ship and office/authorities; up to date intelligence on actual situation in high risk areas. 7 Mark if applicable: the sum of the markings is the frequency</p>