P S M Ltd.

Marine Brokerage and Yacht Services.

__________________________________________________________________________________________________________

Route de Picaterre; Alderney. GY9-3UR Channel Islands.

Tel: 01481-823567 FAX:01481-824968 www.psm-alderney.co.uk E-mail:psm.alderney@virgin.net

REQUEST FOR DELIVERY/POSITIONING VESSEL

I ..............................................................................(full name)

Addresss: ...........................................................................................................................................................................................................................

.............................................................................................................................................

....................................................................................Post Code : aaaaaaaa

Tel. including code:.................................(Home) ..................................(Work)................................(Mobile).........................................(Fax)

Request PSM Ltd. deliver / position the following vessel from

Start location: .............................................................To, end location:.....................................................................(inc. berth number )

The vessel is,....................................................(name) .......................................................(type) ...........................................(SSR/Reg)

Start date: ........................................................................(from) End date: ......................................................................................(by)

VAT is: paid/not paid.........................(delete appropriate)

Please note here any additional information:

....................................................................................................................................................................................................................

....................................................................................................................................................................................................................

....................................................................................................................................................................................................................

I understand and agree that all movements are subject to suitable weather conditions, and movement dates are therefore not finite. I certify that I am the registered owner of the vessel, the registration document is on board and I include here a seperate letter of authority for the Company to move the vessel. I certify that my own insurance for the vessel is valid, and will cover the vessel at all times stated above. Unless otherwise stated, I do not know of any unserviceability, mal function or other reason to impede the progress of the vessel.

Signed : ...........................................Dated: .................................

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