Appendix V – Information to be Included in the Bunker Delivery Note (Regulation 18.5)
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Appendix V – Information to be Included in the Bunker Delivery Note (Regulation 18.5)

1 Name and IMO Number of receiving ship
2 Port
3 Date of commencement of delivery
4 Name, address, and telephone number of marine fuel oil supplier
5 Product name(s)
6 Quantity in metric tons
7 Density at 15oC (kg/m3)footnote
8 Sulphur content (%m/m)footnote
9 A declaration signed and certified by the fuel oil supplier's representative that the fuel oil supplied is in conformity with regulation 18.3 of this Annex and that the sulphur content of the fuel oil supplied does not exceed:
□ the limit value given by regulation 14.1 of this Annex;
□ the limit value given by regulation 14.4 of this Annex; or
□ the purchaser's specified limit value of _____ (% m/m), as completed by the fuel oil supplier's representative and on the basis of the purchaser's notification that the fuel oil is intended to be used:
  • .1 in combination with an equivalent means of compliance in accordance with regulation 4 of this Annex; or

  • .2 is subject to a relevant exemption for a ship to conduct trials for sulphur oxides emission reduction and control technology research in accordance with regulation 3.2 of this Annex.

The declaration shall be completed by the fuel oil supplier's representative by marking the applicable box(es) with a cross (x).

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