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APPENDIX 



REPORT IN ACCORDANCE WITH PARAGRAPH (5) OF 

 ANNEX VI TO THE CONVENTION 



Authorised Officer 



1. Name and nationality, 



2. Name of ship carrying him. 



Position, Date and Time of Occurrence 



3. 

 Provisions of the Convention in question 



4. 

 Information on Each Vessel Involved 



General 



5. Nationality. 



6. Vessel's name and registration. 



7. Skipper's name. 



8. Owner's name and address. 



9. Position, date and time of boarding. 



At the Time of Occurrence 



10. Fishing gear in use. 



11. Stopped, anchored or estimated course and speed. 



12. Signals or lights displayed and sound signals made. 



13. Warnings given to other vessel ( s) . 



14. Direction in which gear was shot or lying. 



15. The horizontal distance gear extended from the vessel. 



Conditions at the Time of Occurrence 



16. Visibility. 



17. Wind force and direction. 



18. State of sea and tide and direction and strength of currents. 



19. Other relevant conditions. 



20. Describe, with the help of diagrams if necessary, the relative 

 positions of vessels and gear. 



21. Marking of any anchored or drifting gear involved. 



Additional Information 



22. Full particulars of loss or damage, giving condition of any 

 gear involved. 



23. Narrative description of occurrence. 



