MASTER’S FOLDER NO: 37

LETTER OF INDEMNITY/UNDERTAKING

TO , OWNERS OF M/V ,
THE MASTER, MANAGERS, SERVANTS, AGENTS AND/OR ANY OTHER PARTY
THAT MAY BE RESPONSIBLE BY CONTRACT OR OTHERWISE.

IN CONSIDERATION OF YOU ALLOWING ME TO BOARD THE VESSEL FOR, A

VISIT / INSPECTION / VOYAGE (DELETE AS APPROPRIATE), I HEREBY
UNDERTAKE AND AGREE ON BEHALF OF MYSELF, MY HEIRS, EXECUTORS
AND ASSIGNEES, THE FOLLOWING :

1. THAT MY ATTENDANCE ON BOARD IS ABSOLUTELY AT MY OWN

RISK THAT NONE OF YOU SHALL HAVE ANY RESPONSIBILITY AND /
OR LIABILITY WHATSOEVER TO ME ON ACCOUNT OF OR IN
RESPECT OF THE LOSS OF MY LIFE, PERSONAL INJURY, ILLNESS,
OR OF ANY OTHER LOSS OR CLAIM OF ANY ACCOUNT OF
WHATSOEVER NATURE AND HOWSOEVER ARISING EVEN IF SAME
IS DUE TO THE NEGLIGENCE OR ANY ACT OR OMISSION OF ANY OF
YOU OR FROM ANY DEFECTS IN THE VESSEL OR OTHERWISE
BROUGHT DIRECTLY OR INDIRECTLY BY THE UNDERSIGNED OR
BY ANY OF HIS DEPENDANTS OR OTHER.

2. TO FULLY INDEMNIFY AND HOLD YOU HARMLESS AGAINST ANY

AND ALL PENALTIES, FINES, LOSSES, EXPENSES, CLAIMS,
LIABILITIES, (INCLUDING ALL THE COSTS OF DEFENDING SUCH
CLAIMS) WHATSOEVER, AS WELL AS ANY MEDICAL, REPATRIATION
OR DEVIATION EXPENSES THAT MAY INCUR AS A RESULT OF ANY
ACT/NEGLIGENCE/OMISSION/DEFAULT/ILLNESS/INJURY/DEATH
SUSTAINED BY THE UNDERSIGNED WHILST ON BOARD
HOWSOEVER CAUSED.

THIS INDEMNITY/UNDERTAKING SHALL BE GOVERNED BY AND

CONSTRUED IN ACCORDANCE WITH ENGLISH LAW. ANY DISPUTE ARISING
OUT OF THIS INDEMNITY/UNDERTAKING IS TO BE DECIDED BY THE
ENGLISH HIGH COURT TO THE EXCLUSION OF THE COURTS OR TRIBUNALS
OF ANY OTHER JURISDICTION.

THE UNDERSIGNED FULLY WARRANTS TO HAVE READ AND UNDERSTOOD

IN FULL THE ABOVE AND TO HAVE WILLINGLY AGREED TO ITS TERMS.

PLACE SIGNED
DATE
TIME

THE UNDERSIGNED

NAME :
ADDRESS :
PASSPORT NO :

FORM - VSL - DEK - 044

Prepared by Approved by Issue No. Revision No. Date Effective Page No.

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