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Number of Decks
Number of Masts

Nature of, and whether standing Gallery
or running Bowsprit.

Round, square, or other Descrip- Framework


Carvel or Clincher.
Description of
Kind of.
Wood or other Material.




Measurements. Length from the Forepart of Stem under the Bowsprit to the Aftside of the Head of the

Sternpost Main Breadth to Outside of Plank Depth in Hold from Tonnage Deck to Ceiling at Midships

No. of Tons.

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(*) Additional Particulars for Steamers. Deduction for Space required for

. Propelling Power (say whether ofths or oths, or as measured)

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in the County of

[Secretary], or [duly appointed public Oficer), of the

an Act or Ordinance of the the Act 7 & 8 Vict. c. 110. United Kingdom [cite the (a Charter granted by Her Legislature of

from the Day of Year in which the Act was or Majesty, and dated the

[cite Year in which the Act or being the Date of the Cerpassed, its Chapter und Day of

or Ordinance was passed, its tificate of complete RegistraTitle).

Chapter and Title).

(2.) The said Company is subject to the Laws

Possession of
and has its principal Place of Business at
(3.) The said Company is entitled to be registered as Transferee of

Shares in the said Ship.
And I make this solemn Declaration conscientiously believing the same to be true.

Dated at


(Name of Registrar.]

(oOmit this Part if she has no Steam Power.

Length of Engine Room (if measured)


Combined Power (estimated Horse-power)

Register Tonnage, (after making Deduction for

Space for Propelling Power in Steamers) (a)

I, the undersigned A.B., of

Company, declare as follows:
(1.) The said Company was incorporated by or by virtue of
an Act of Parliament of the

of the British
of the United Kingdom, }or{

Day of Made and subscribed by the above-named A.B, in the Presence of me

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(6) Alter accordingly if inore than One Person makes the Decla

(1.) I am a natural-born Subject of Her Majesty, boru at [sraming Place of Birth)




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and have since I took the Oath of Alle

giance to a Foreign State (naming State] and have never taken the Oath of

and on the Allegiance

Day of to any Foreign State.

or taken the Oath of Allegiance to Her
Majesty, and am residente at

If the Declar[naming Place] being a Place within ant is a naturalHer Majesty's Dominions.

born Subject who or

has taken the

Oath of Allegi

naturalized by an Ordi- ance to a Foreign I am

(naturalized by Act of Par pance of the proper legis- State, or a Deni

liament of the United lative Authority of zen or a naturala Denizen by Letters Kingdom [cite the Year or

[naming British ized Subject, and of Denization dated the

in which the Act was Possession] [cite the Year is resident in Day of

passed, its Chapter and in which the Ordinance a Country not

Land Title.]
was passed, its Chapter within Her Ma-

jesty's Domi

nions, he must and am resident at [naming Place], being a place within Her Majesty's Dominions.

declare in addition, that " he is

Member of And I have

some British since I so became since the passing of the said Act or Ordnance,

" Factory, Partor Denizen,

ner in

House actually and on the


Day of
, taken the Oath and Allegiance to Her Majesty.

Business in the
United King-

dom or in some (2.) I declare that the

British PossesPerson appearing by the

sion(naming Register Book to be the

the House and Owner of Shares

also the Place in the Ship above des We declare that C.D.,)

I declare that on the where it carries cribedt (died at the Person appearing on

Day of

I in- on its Business]. in the County of the Register Book to be the

termarried with and am Alter according having first Owner of Shares in

now the Husband of C.D, duly made his Wiù dated the Ship above described


the Person appearing on the Day of

was on the

Day of whereby he appointed

† [duly adjudged a

the Register Book to be

the Owner of Shares me Erecutor, and I Bankrupt], or (declared

in the said Ship, and I deproved his said Will on or insolvent], and that we or

clare that on such Marthe Day of were on the


riage the Interest of the in the Court of .] of appointed Assig.

said C.D. became by Law or [died at nees of the said C.D., and

vested in me, and that I the County of we are by Law entitled to

am entitled to be registhe Day of be registered as Owners of

tered as Owner of the said intestate, and that Let the said Shares of the

Shares in place of the said ters of Administration said Ship in place of the

C.D. of his Estate and Effects said C.D. ecere on the Day

duly granted to me by the Court of



(3.) To the best of my Knowledge and Belief, no Person or Body of Persons other than such Persons or Bodies of Persons as are by The Merchant Shipping Act, 1854, qualified to be Owners of British Ships, is entitled as Owner to any Interest whatever, either legal or beneficial, in the said Ship.

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

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