Fifth Schedule



issued by the
Govt. of India



Name, Port of Registry,
 And Official No. of vesse
Name and Residences of Owner and
Title of Claim.
1 2 3



*In any case of doubt as to title the declaration specified in Part II of this Schedule should be required to be made


* Obliterate words that do not apply.

Reference No in Report Book Description of Property and of Marks, thereon, if any. Estimated Value. Memorandum of all Charges paid by owner on delivery of Property.
4 5 6 7

Total Value


I hereby certify that the claimant in this case has produced satisfactory proof of ownership, or agency assignation of interests and that I consider him entitled to the @ (net proceede c,� sale) property descrited in column 5 above; payment of all just expenses as stated in column 7 3ve having been made.

   Rs. P.           Rs. P.

If sold Gross Proceeds
 Charges paid viz :�
 Incidental expenses
 Such as warehouse rent
 Fees payable to Receiver .
 Fees, if any, payable to the Valuer

Charge outstanding viz :�

 Incidental expenses
 Fees payable to Receiver
 Fees, if any, payable to the Valuer

             Total Charges    Net Proceeds.

Received this . . �����... .day of��� 19

of the Receiver at ��������..the

@(net proceeds of sale of the) property described form column 5 above. Revenue stamp of appropriate value to be affixed if payment in Cash exceeds Rs. 20.



Dated this ��������.. day of ������..19

Signature of Receiver                                                                                                           






Declaration to be made by Claimant when Receiver has any doubt as to his Title.
 Description of Documents produced in support of Claim







I, ��������������� solemnly and Sincerely declare,


1.                 That the particulars contained in Columns 1, 2, 3,4, 5 & 7 of the Form on the other side hereof are correct and true.

2.                 That I am entitled to possession of the property, described therein, and that I hereby claim possession of the said property, subject to the payment of all just expenses.

3.                 That the document produced herewith, as evidence of ownership, agency or assignation of interests and described in column 8 of the said Form are true and genuine documents, and that the said �������������..mentioned in such documents is the said �������..abovenamed.

And I make this solemn declaration conscientiously believing the same to be true.



Signature of Claimant


Declared before me at ��������
 this ������ of �����.19
 Signature of Receiver


Date of Receipt Estimated value Description of property Name & Address of owners (if known) Name official No. and Port of Registry of vessel (if known) Date when found Exact Spot where found Services rendered Name of Salvor Address of Salvor
1 2 3 4 5 6 7 8 9 10



Transaction in respect of Wreck Particulars of wreck Sold Wreck delivered or sale proceeds paid to owners
Charges on the wreck Account of money received from owners Date of sale To whom sold Amount realized by sale Net proceeds to be paid to Owners or held in deposit under section 398 of the M.S. Act. 1985 Date of payment of delivery. To whom paid or delivered. Whether Owner or Agent etc. Reference Vouchers and Correspondence or particulars entered over leaft.
11 12 13      14 15 16 17 18 19 20
 Rs. P.  Rs. P.    Rs. P.  Rs. P.        
 1. Travelling  As deposit for salvage etc.   Gross proceeds
Deduct Expenses per column 11.
2. Incidental expenses such as warehouse, rent cartage, etc. Of which was disposed of in payment of charges as per contract.              
3. Fees payable to Receiver. Balance of deposit returned to owners              
4. Fees, if any, payable to the valuer. As payment of charges as per contract.              
5. Customs duties.                
6. Salvage Total Charges.                



Reference Number                                                      Further Particulars


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