STATEMENT OF LIABILITY

The undesigned.............................................................. in my capacity of

owner / operator of the ship.................................................... (IMO number )
hereby declare on my own liability that the above mentioned ship has been
effectively and prevailingly used in the open sea during the period of its being
under ownership or operation, for the last five years prior to the date of
delivery of goods / services provided to its benefit.

Master/ Shipowner / Operator

Signature and stamp,

Date,