death on board 23.06.11 mca form

8/3/2019 Death on Board 23.06.11 MCA Form

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Departmentor Transport[ \ t l o r r h e n t C , h i n n i n n A r t

Report y Master r otherperson f a BirthorR - - r L ! - - F - - - ! - - r a l - ! - . D - - - - r - l - - - t - : l - a l - ^MerchantShipping Returns f Birthsand Deaths)Regulations 979lmportant:TheConsul r otherOfficer broad owhom his eport sgiven, houldorwardt withoutdelay,BYAlR,whenever ossible irect o:-Registry f shipping& Seamen

MCA CardiffAnchorCourtOceanWayCard ffCF24sJWTel:02920448800Fax:02920448820E-mailss .ukPortof Registryndname ndaddress f ownersameof ship

A3i0P" tqA"5SA,JRf rr .(o N r&vzFftxef bmtrHErHSf Err . l ;>f l .^s ' :>E56rc'fsM NcHENGgP$^ r,.rY

OfficialNumber

+4,3t9INSTRUCTIONSO CONSULS SHIPPING ASTERS

eport s intendedor useonly or Births& Deathswhichoccur n a non-UK egisteredhip. Theof a foreign hipcan onlybe requiredo makea Return f Birthor Death f they callat theKingdominwhich asea formRBD1 s used).portsabroada ProperOfficermay receive nformationhat a citizenof the UnitedKingdom r* hasbeenbornor hasdiedon a foreign h ipwhichhasarrivedwithin isdistrict ndwhichnotproceedingo the UnitedKingdom. n suchcases heyshould ndeavouro get he Master fo completehis ormwhichwill orm he basisof registrationf theBirthor Death. t is mosthata Master f a foreign hipwillhavea supply f these ormsand heProperOfficer houldrovidet from heirown stock.

essentialn thesecases or he report o be madeby theMaster f theshipbut t is desirableheyshoulddo so. lf the Masters unable o completehe orm hen t shouldbe completed yeliable erson aving he knowledge f the acts. lf a ll the actsare notknown, s manyofas areknown hould e recorded erein.

eProperOfficer hould e satisfiedhat hevessels a sea-goinghip.

In heship ncludes:na ship's oatof ship'sife-raft;eingos t roma ship ncludes:ship's oator ship'sife-raft.Citizen f the UnitedKingdom r Colonies nder he BritishNationalityct 1981meansa BritishCitizen,Britisherritories itizen,Overseas itizen r under he HongKong BritishNationality) rder1986,a BritishNational

(RBD )REV8IO7SF4606


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of Place fBirth(LatitudeLongitudefatsea)

Forenames(ifany)andSurnamefchildSex Father*Name, urname& NationalitY Occupation,ankorProfession& usual esidence

if thechilds llegitimate,heparticularsf the athermustnot be givenunlesst is at the ointiven nwriting f themother nd heperson cknowledgingimselfo be he ather' nwhichsuchperson hall,"" *Ji "" themother, ignhereport'Thewritten equest hould eattached

this eport

DateofDeath

6Yl2orl

Placeof Death(LatitudeLongitudefat sea)

Name& Surname fDeceasedalsomaidennameof womanwho hasmarried,f known)

Sex Dateof Birth ifknown)orage

t - / - , :5E '45,5 'Nr-oN" Ocq"uh,2'E

np_S l'4ApV 5lvr TH FEI \LE 4+losl41\G'

Thisreportwas made o me at the dateand placeshownhereunderSignature f officerTitleof officerDate


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Name, urname& NationalitySignaturefFather* nd/orMother f hechildsualResidenceaiden urname ndSurname tMarriagef different

Occupation,ankor profession Usualresidencettimeof DeathNationality Causeof Death*

PED T'ACFIEP

Certificate o be signed by the Master,or other person making the report.I certifyhat o thebestof my knowledgendbelief heparticularsn his eport recorrect nd rue.

SignatureQualificationMasteretc) 5IA 7( CAtri'A NDate

Address q 6 wrbHST*TVENDANM 2

,*i


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ffi:

particulars n respectof deceasedmemberof the crew, f known:

ndof nextof kin

ookNo.

of entryor entries elating o deathappearingn the narrative ectionof theOfficialLogor otherofficial ecord.Dateandhourof he Placeof theoccurrenceor situation yLatitudeandLongitudet sea

Date fentry Narration

death on board 23.06.11 mca form

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