| (Schedule 1 paragraph 16) |
| The Port Manager, Castries/Vieux-Fort |
| APPLICATION FOR A BERTH |
| We the undersigned.................................... *Owner/Master/ Agents of the S/M/V Sch ....................... GRT ........................ |
| LGTH ........................ Draft Fwd ................... Aft .............. |
| Registered No ...................... request that a berth at .................... be allowed to this vessel on the ................................ 20 .......... for the purpose of discharging/loading *and/or disembarking passengers. |
| I hereby declare and certify as follows— |
| *(a) | The vessel is not carrying any dangerous goods described in the list of dangerous goods in the .................. schedule. |
| (b) | The vessel is not carrying explosives or goods possessing dangerous properties other than those described in the list of dangerous goods. |
| (c) | The vessel is carrying dangerous goods as shown on the back thereof. |
| (d) | The vessel is carrying explosives or goods possessing dangerous properties other than those described in the list of dangerous goods as shown on the back thereof. |
| (e) | The packing and storage of all goods listed under (c) and (d) above are in accordance with the usual shipping practice except as shown on back thereof. |
| (f) | The amount of cargo to be discharged is ............ tons. |
| (g) | The amount to be loaded is .......................... tons. |
| (h) | The amount of deck cargo is ........................ tons. |
| (i) | The number of passengers disembarking is .......... Embarking .................. |
| (j) | The vessel is expected to arrive in the harbour at ......... hours. |
| Signed ................................ |
| Master/Agent. |
| * Cross out whichever is not applicable. State number of tons of each type of cargo. (To be submitted in quadruplicate). |