Republic of the Philippines)

City of Lucena ) S.S.

x-----------------------x

MARINE PROTEST

Name: Age:
Civil Status: (Married/Single)
Address:
Position:
Home Port:
Registry Number:
Gross Tons: Net Tons:

After being duly sworn to in accordance with law, I do hereby declare and state on
protest:

1. That on (continue with the facts and circumstances that transpired in the incident);
2. That I, as Master, (Indicate what actions the master initiated);
3. That I, as Master, (Indicate the respondents and their address if any);
4. That the prevailing weather at the time was as follows:
5. General Description: ___________________________________________________
6. Wind Direction: _________________ Velocity: _________ Kits: ________________
7. Height of Seas: _________________ Feet: ______________
8. Tide: ___________________________ Flood: _____________
9. Visibility: ____________________________________________
10. Other Remarks: _____________________________________
11. That the incident resulted injuries to ___________________________ persons and death
to ___________________________ persons, whose names are listed in Exhibit “A” of
this PROTEST;
12. That this incident likewise resulted to loss or sight damage to the
_____________________ belonging to ________________________ in the estimated
amount of _____________________________________ (P___________) and detailed in
Exhibit “B” of this PROTEST;
13. That my organization / shipping company is as follows:
14. Company: ______________________________
15. Address: ________________________________
16. Telephone(s): ___________________________
17. Fax: _____________________________________
18. That further / additional information / data is appended hereto as Exhibit “1” of this
PROTEST.

Name
Ship Captain

(JURAT)
NOTE: When SUMMARY OF CASES WHERE THE PROTEST IS REQUIRED
(CODE OF COMMERCE)
SECTION AND RULES
1. Under 612, when the vessel makes an arrival under stress;
2. Under 612, 624, and 843, where the vessel is shipwrecked;
3. Under 624, where the vessel has gone through a hurricane or when the captain
believes that the cargo has suffered damages or averages; and
4. Under 835, in case of maritime collisions.