Outer cover for

List of Crew and

List of Young Persons
MSF 4156 (Rev 11/13)

Name of ship:

Port of choice

Official number

Gross tonnage

*M/V, *S/S., *M/Y, *S/Y

Nett tonnage

(*Delete whichever is inappropriate)

Kilowatts

Name and address of shipowner

Description of the ship (e.g. motor ship, steamship, motor

yacht, sailing yacht etc)

Date and place of commencement of crew agreement

Date and place of termination of crew agreement

Date ______________________

Date ______________________

Place_______________________

Place_______________________

Signature of master ____________________________________

Signature of master ______________________________

OFFICIAL USE
Received by the Maritime and Coastguard Agency/Proper Officer
at _____________________________________________ on _______________________