Note for claim of Collision Liability.

To: The Master and Owners of “ (name of the other ship) “ of the port of (registry port)

Re: Collision on (date of collision) at (place of collision)

I, the Master of the vessel” … (name of our ship) … “ of the port of … (registry port) … for myself and

for and on behalf of the owners of “ … (name of our ship) … “ hold you fully responsible and liable

for the damages and loss caused as a result of the collision between your vessel” … name of the

other ship) … “ and my said vessel which occurred on … (date of collision) … at about … (time of the

collision) … hours at … (place of collision) …

Dated the … (date of the making of this letter) …

(signed and chopped)

Capt. … (name of our ship’s Master)

Acknowledge the receive by:

(signed and chopped)

(name)

Master / Owners of “ …. (name of the other ship)