Statement of Termination of Salvage Assistance Rendered to the Vessel in Distress

Type and name of ship) ________________ _______________ owned by (State, Ministry, Company or private Firm) ________________ ____________________ performed by the vessel (name of ship) _________________________________

1. Geographical location of accident at sea and of the place where assistance has been rendered (ocean, sea, latitude, longitude, port, etc.) ____________________

2. Time of accident (date, hour, minutes) by the distressed ship's Log Book _____

3. Time of arrival of salvors (date, hour, minutes) __________________________

4. Time when the distressed vessel consented to accept salvage assistance, or when the Salvage Agreement has been signed (date, hour, minutes)…