[N.B.-Any of the Particulars not known, or not required, by reason of the Claim being only against the Cargo, &c., may be omitted.]U.K.
Whereas certain salvage services are alleged to have been rendered by the vessel [ insert names of vessel and of commander ], commander, to the merchant vessel [ insert names of vessel and master ], master, belonging to [ name and place of business or residence of owner of vessel ], freighted by [ the same of the freighter ], and to the cargo therein, consisting of [ state very shortly the descriptions and quantities of the goods, and the names and addresses of their owners and consignees ]:
And whereas the said vessel and cargo have been brought into the port of [ insert name and situation of port ], and a statement of the salvage claim has been sent to [ insert the name of the consular officer or judge of the Colonial Court of Admiralty or Vice-Admiralty Court and of the office he fills ], and he has fixed the amount to be inserted in this bond at the sum of [ state the sum ].
Now I, the said [ master’s name ], do hereby, in pursuance of the Merchant Shipping Act, 1894, bind the several owners for the time being of the said vessel and of the cargo therein and of the freight payable in respect of that cargo and their respective heirs, executors, and administrators, to pay among them such sum not exceeding the said sum of [ state the sum fixed ], in such proportions and to such persons as [ if the parties agree on any other court, substitute the name of it here ], the High Court in England shall adjudge to be payable as salvage for the services so alleged to have been rendered as aforesaid.
In witness whereof I have hereunto set my hand and seal, this [ insert the date ] day of
Signed, sealed, and delivered by the said [ master’s name ].(L.S.)
In the presence of [ name of consular officer or judge of the Colonial Court of Admiralty or Vice-Admiralty Court, and of the office he fills. ].