I/we*, having obtained permission from the owner (where relevant), hereby request that you conduct a survey, in accordance with the scope of work, subject to your normal terms and conditions, which I have received, read and understood, and to any special instructions listed below, on the vessel;

Named:………………………………………….......Type:……………………...................

………………………………………………………………………………………………….

to be inspected at: ……………………………………………………………………………

………………………………………………………………..…on: (date) ………….………

I/we* hereby agree to pay any fees and expenses reasonably incurred and charged by the surveyor and understand that I am/we are* responsible for all charges for boat movements, slipping, docking, removals, replacements and reinstatement work arising in preparation for and process of the survey.

Fee quoted at: ………………………………………………..…………

Expenses estimated at……………………………………………….

Vessel owner’s or broker’s name and phone number (if different)

Please advise any special instructions:

Client’s name(s):

…………………………………………………..............…….............................…………

Address:……………………………………………………………………………………...

…………………………………………………………………………………………………

…………………………………………………………………………………..………………

Telephone:…………………………………........Mobile phone.....……...........……… …

Signed…………………………................................Date: .......................………………

(*) means please delete as appropriate.