Completed worksheet may be emailed to

United States Coast Guard sans@nvmc.uscg.gov

National Vessel Movement Center

NON-CREW AND PASSENGER LIST

Country of
Vessel Name Call Sign Vessel ID Number
Registry

IMO Official No.

Name in Full Identification (ID) - Passport or
Date of Birth Nationality Merchant Mariner's Doc Where Embarked (Port
Family Name Given Name and Initial (MM/DD/YY) Type Number or Place & Country)

Notice of Arrival (NOA) Non-Crew and Passenger List, Version 4.0, December 18, 2003 4 of 6