DECLARATION AND AFFIDAVIT

of Non-Registration

According to Liberian Maritime Law

Vessel Name / Official Number
IMO Number
Builder / Year Built
Registered Owner
Residence / 80 Broad Street, Monrovia

The undersigned duly swear,

(i)  that I am Attorney-in-fact, authorized in writing, of the Owner (the “Company”) of the foregoing described vessel (“the Vessel”);

(ii)  that the Company has applied for the registration of the Vessel under the Liberian flag;

(iii)  that the Vessel is currently not flying another flag; and will not be registered in another flag prior to registering under the Liberian flag.

(iv)  the Vessel is free and clear of recorded liens and encumbrances.

Submitted by:

Full Name
Citizen of
Residing at

______

(Signature) (Date)

Subscribed and sworn before me

this ____ day of ______, at ______.

______

Signature and Title

(of Special Agent or Notary Public, etc.)

AFF-130 REV 04/15