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Vigilate

Government of The British Virgin Islands

MERCHANT SHIPPING ACT 2001 REGISTRY OF SHIPPING

Virgin Island

BUILDER'S CERTIFICATE

Note: Please complete in BLOCK LETTERS

Yard Number Name of Vessel Date of Build
Details of Vessel
Length Metres/Ft. Method of propulsion (sail, motor, or both)
Breath Metres/Ft. Make of engine
Depth Metres/Ft. Estimated tonnage of vessel
Builder's Name Builder’s Address Place of build ( if different from builder’s address)

*I/We hereby certify that *I/We built/moulded/fitted out the vessel described above to the order of:-

Full Name(s) Full Address(es) Occupation(s)

Note: If two or more persons are to own the vessel jointly, please give all their details in full and add the words “as joint owners" in the box above.

Date Signature of Builder

In the case of a body corporate, this certificate must be sealed and witnessed.

Status of Witness i.e. Director, Secretary Address
Name .

(print)

Signature .

*Delete as necessary

Note: Builders can use their own printed form provi ded that all details shown above are included.

FORMERLY ROS 8SR101-03 (03/10)