CERTIFICATES TO ACCOMPANY THIS CLAIM.

Certificate by Two Householders of the Parish.

We, the undersigned, being both inhabitant householders of the parish of

, at

in the county of

who has sub

hereby certify that we personally know 5

scribed the above declaration, and that we firmly believe him to be the person named or referred to in the will of the deceased as

Signatures
of

Two Inhabitants. S

Their Residence

and Occupation.

Declaration by Shipping Master or Minister."

and

I certify that I know or have ascertained the above-named to be respectable householders of the parish above-named in that behalf; and that I have no reason to doubt the truth of the statements made by the claimant.

Shipping Master at the Port of

Signed

; or, Minister of

II. Certificate of attesting Witness of Will."

I, the undersigned, certify that I saw the above-named deceased sign his will at 10

and that such will was on

on the

day of

;

sheet of paper; and I certify

4 This declaration to be signed by two respectable inhabitant householders of the parish where the claimant resides.

5 Here insert name of claimant.

6 Here insert the character in which the claim is made, whether as executor, legatee, etc., taking it from the declaration, as at 3 above.

If the claimant resides at or near a seaport, this declaration must be signed by the shipping master; if not, by the minister of the parish in which the householders reside.

8 Here insert names of householders who have signed the previous certificate.

This is to be signed before a clergyman or magistrate by the witness (if any) who attested the signature of the Will, or by some person who saw the Will attested.

10 Here insert the time and place at which the Will was signed.

that the will shown to me at the time of making the declaration is the will which I saw the deceased sign.

the

I, the undersigned, certify that I knew personally above-named deceased seaman, and am well acquainted with his handwriting; that a will, dated and made on

sheet of paper, has been produced to me; 12 that I have signed my name on the back of it; and that I firmly believe the signature of the said will to be the handwriting of the said deceased seaman.

Declared and subscribed before me,

day of

18

, by

respectable inhabitant of my Parish.

(The Magistrate or resident Minister of the Parish to sign here, and state the place for which he acts.) Magistrate for

; or, Minister of

this

County of

(Signature, Residence, and Occupation of the Person or Persons testifying to the Handwriting.)

Description of Claimant.

The following description of the claimant is to be taken by the shipping master, if at a port, or if claimant does not reside at or near a port, by the minister of the parish, in order to identify the party in case of fraudulent application for the wages and effects of the deceased

11 This is to be signed by some one who was well acquainted with the handwriting of the testator, in the presence of the minister or of a magistrate of the parish in which he resides.

12 The person signing this certificate is also to sign his name on the Will.

Information to be given by the Claimant.

As the claim cannot be investigated without information on the following points, such information should be given by the claimant in the respective blank places below left for that purpose. If there are no relations of the degrees stated below, insert the word "None" in the appropriate space.

INSTRUCTIONS TO CLAIMANTS.

If the claimant possesses any letters from the deceased, or any other papers or documents which may serve to identify him in case of doubt, the same must be sent, with this claim, to the Board of Trade.

If an executor is named in the Will, he is the first person entitled to claim payment: if there is no executor, or if he refuses to claim, the person to whom the property of the deceased is given by the Will is entitled to claim. If there are two or more executors, or two or more legatees, entitled to claim, they must either make the claim jointly, or if one only claims, the consent in writing of the others must be sent, and must accompany this application.

If the Will, or any of the certificates and documents, or information hereby required, cannot be obtained, and sent with the claim, the reason is to be stated here.

(Signed)

Claimant.

The Board of Trade may, in its discretion, refuse to pay or deliver any such wages or effects as aforesaid to any person claiming to be entitled thereto under a Will made on board ship, unless such Will is in writing, and is signed or acknowledged by the testator in the presence of the master or first or only mate of the ship, and is attested by such master or mate.

It may, in its discretion, refuse to pay or deliver any such wages or effects as aforesaid to any person not being related to the testator by blood or marriage who claims to be entitled thereto under a Will made elsewhere than on board ship, unless such Will is in writing, and is signed or acknowledged by the testator, in the presence of two witnesses, one of whom is some shipping master appointed under the Merchant Shipping Act, or some minister or officiating minister or curate of the place in which the same is made, or, in a place where there are no such persons, some Justice of the Peace, or some British Consular officer, or some officer of Customs, and is attested by such witnesses; and whenever any claim under a Will is rejected by the Board of Trade on account of the said Will not being made and attested as hereinbefore required, the wages and effects of the deceased will be dealt with as if no Will had been made.

N.B.-Any payment which may be made in consequence of this application will not entitle the applicant to appropriate the money to his or her own use, if there are others who have legal claims on it, either as legatees under the Will or as creditors; and such persons will have the same rights against the applicant, and the same means of enforcing it, as if the claimant had taken out probate in due course of law for the purpose of administering the property of the deceased amongst the persons interested.

N.B. Every person who, for the purpose of obtaining, either for himself or for another, any money or effects of any deceased seaman or apprentice, forges, assists in forging, or procures to be forged, or fraudulently alters, assists in fraudulently altering, or procures to be fraudulently altered, any document purporting to show, or assist in showing, a right to such wages or effects; and every person who, for the purpose aforesaid, makes use of any such forged or altered document as aforesaid; or who, for the purpose aforesaid, gives or makes, or procures to be given or made, or assists in giving or making, or procuring to be given or made, any false evidence or representation, knowing the same to be false, will be punishable with penal servitude for a term not exceeding four years, or with imprisonment, with or without hard labour, for any period not exceeding two years, or if summarily prose

cuted and convicted by imprisonment, with or without hard labour, for any period not exceeding six months.

When properly filled up and attested, and the information and documents supplied, this Application is, if the Claimant lives in or near a Seaport, to be delivered to the Shipping Master, who will forward it to the Board of Trade; if the Claimant does not live in or near a Seaport, he must forward it himself to The Secretary,

Marine Department,

Board of Trade,

Delivered to the Shipping Master of the Port of day of

18
(Signed)

No. of his Certificate (if any).

Shipping Master.

NOTE.—The above entries are to be filled up by the Master, and the log book is to be delivered to the Shipping Master within forty-eight hours after the ship's arrival, or upon the discharge of the crew, whichever first happens, in the case of a "Foreign-going Ship;" and within twenty-one days after the 30th of June and the 31st of December respectively in every year in the case of a "Home Trade Ship."