This is to certify that (here insert the names, occupation and residence of the owners)
having declared that (he or they) are sole owner or owners of the vessel (fishing-vessel or
harbour-craft) called (the name) which is of the burthen of (number of 1
[tons])and that the said
vessel (fishing-vessel or harbour-craft) was (where and when built), the said vessel (fishingvessel or harbour-craft) has been duly registered at the port of (name of port).
Certified under my hand.
(Signature of Officer)
_________