Third Schedule


[ See rule 6(2)] � :

Issued by the

Government of India


Report of Derelict Vessel, or Floating Wreckage, or Sunken Wreck

    Queries                                                                                                      Replies

1.       Name and address of informant                                                              1
2.       Name and port of the vessel to which she belongs.                            2.
3.       Voyage.                                                                                                          3.

4.       (a) Nature and size  of obstruction                                                           4. (a)
4.       (b) Nature of danger to navigation                                                            4. (b)

5.       Name and port of derelict or sunken wreck                                            5.
          if known, and if not known, any particulars
          which might lead to its identification.

6.       Description of the wreckage and any marks                                        6.
           which might lead to its destination.

7.       Date and hour when the derelict, wreckage,                                        7.
           wreck was last seen and date and hour of
           report made by radio telegraphy, if fitted.

8.       If sunken wreck, the exact spot in which                                                8.
          lying and the bearings of any fixed Object
          that can be give a (Tracing from charge showing exact spot).

9.       If a derelict or floating wreckage the place                                           9.
          where last seen, and the direction in which drifting.

10.     Whether the derelict was boarded by the                                           10.
           informant or any of his crew.

11.     Whether she was dismasted                                                               11.

12.     Whether she was waterlogged                                                             12.

13.     Whether she had capsized                                                                    13.

14.     Did she appear to have been in collision.                                         14.

15.     If laden, the nature of her cargo                                                           15.

16.     Was any attempt made to take her In tow                                          16.
or to destroy her, and if why not.

17.    Any other particulars which the Receiver                                             17.
may think relevant.

18.     Date of making this report                                                                      18.

19.    Date of informing underwriters or their agents                                   19.

Note�The questions which do not apply should be struck-out.

Forwarded to the Principal Officer,
Mercantile Marine Department,
Dated,, this ���������day of �������.19

Signature Of Receiver

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