BRAVE ROYAL SHIP MANAGEMENT (BD) LIMITED.

FILE NO. F – 20. BRSML/FORM-20-R0

SHIPBOARD EMERGENCY REPORT FORM

Name of ship: Port : Berth:

At Sea-lat.: Long: Date

Time : Port to : From :

01 Nature of casualty (collision, grounding, fire, oil spill, etc):

02 Nature and extent of damage:

03 Cargo

04 Name of Charterer or agent with any contact names and after hours or emergency phone numbers:

05 Name, nationality, type, fax & Tel number and situation of any other ship involved:

06 Any casualties or fatalities:

07 Nature of any services required (towage, helicopter, lifeboat, medical, fire, etc).:

08 Services already summoned:

09 National, local or any other authorities or agencies already informed:

10 State of weather and sea, present and forecast:

11 Other relevant comments:

12 Date and time of report.:

In the event of a spillage of cargo or bunkers the following items should be added:

01 Type of oil or cargo spilled

02 Cause of incident, if known e.g. overflow, burst hoses, hull damage, etc

03 Estimate of quantity spilled

04 Estimated current rate of spillage

05 Whether clean up has been attempted by ship or a third party.

Received/Sent by: ________________________________ Time : ___________Date: _______________

Original: Office (DPA)

Copy: Retain on board.