Shipyards Statement:

Shipyard’s name invites the following persons to their location in City. to perform essential services for the construction, refit or commissioning of Ship’s name or yard number.

Name	Nationality	Passport Number

Destination shipyard:

Name	Shipyard’s name

Address	Address

City	City

Contact person	Name and Surname

Telephone number	Telephone number

Details of ship:

Name or yard number	Ship’s name or yard number.

Length	in m	Ship’s length.

Date Date.	Signature