Official number	Ship’s name

Particulars of sale

Seller’s full name and residential address	Buyer’s full name and residential address1

NOTE

1 The address must be: Residential address (not PO Box) - for an individual; Principal place of business - for a foreign company or statutory body; Registered office address – Australian company.

Amount paid, or consideration	Number of shares transferred (total of 64 shares)

Declaration

I, the registered owner and seller, hereby acknowledge the transfer of shares in the ship described above to the buyer for the amount shown. Further, for myself and my successors I covenant with the buyer and his/her/their assigns that I have power to transfer the shares.

Date	Place

Signature of seller(s) If the seller is a corporation, the document may be formally executed under the corporate seal. Alternatively, an officer of the corporation may sign it, endorse it with a legible statement of his/her name and designation and have the signature witnessed.	Signature of witness
Name of witness
Address of witness

Except where indicated by * the collection of information requested in this form is either required or authorised by the Shipping Registration Act 1981 (the Act). It will be used for purposes related to the Act (including possible overseas disclosure) and will be available for public search in circumstances as the Act requires. It may be made available to government agencies for statistical and administrative purposes. Failure to provide the information will result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information or how to make a privacy complaint, visit www.amsa.gov.au/privacy-policy