for Department Transport

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or Report Master other personof a Birthor by

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1979 of Shipping(Returns Births and Deaths)Regulations Merchant given, it should forward without is abroad whomthisreport to or lmportant:TheConsul otherOfficer possible direct to:delay,BYAlR,whenever
& of Registry shipping Seamen MCA Cardiff AnchorCourt OceanWay Cardiff CF24 sJW Nameof ship Number Official

Tel:029 20448800 Fax: 029 20448820 .uk rss E-mail and Portof Registry nameand of address owners
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MASTERS & TO INSTRUCTIONS CONSULS SHIPPING

ship. The registered whichoccurin a non-UK & for This reportis intended useonlyfor Births Deaths to Masterof a foreignship can only be required makea Returnof Birthor Deathif they call at the (inwhichcasea formRBD1is used). Kingdom United or that At portsabroada ProperOfficermay receiveinformation a citizenof the UnitedKingdom and withinhis district which shipwhichhasarrived Colonies has beenbornor hasdiedon a foreign "* of to to not proceeding the UnitedKingdom.In suchcasestheyshouldendeavour get the Master is Birthor Death. lt is most of this the shipto complete formwhichwillformthe basisof registration the should Officer of of shipwill havea supply theseformsandthe Proper unlikely a Master a foreign that provideit fromtheirown stock. therefore of to in It is notessential thesecasesfor the report be madeby the Master the shipbut it is desirable by the to that theyshoulddo so. lf the Masteris unable complete formthen it shouldbe completed as person of having knowledge the facts. lf all the factsare not known, manyof the reliable another herein. be should recorded themas are known ship. is that should satisfied the vessel a sea-going be Officer The Proper

* In theshipincludes: a ship's life-raft. a boator ship's life-raft; being froma shipincludes: ship's lost in boatof ship's *" Citizen the UnitedKingdom Colonies Citizen, British Act or underthe BritishNationality 1981meansa British of Order1986,a BritishNational or underthe HongKong(BritishNationality) Citizen, Overseas Citizen Territories Dependent (Overseas).

(RBD 3) MSF4606 REV8IO7

Births Father*
Sex

Date of Birth

Placeof Birth & (Latitude if Longitude sea) at

Forenames (if any)and of Surname child

Surname Name, & NationalitY

rank Occupation, or Profession residence & usual

it *Note:if the childis illegitimate, particulars thefathermust not be givenunless is at thejoint of the to himself be thefather'in which acknowledging and of givenin writing the mother the person request be should attached request signthe report'Thewritten the mother, shall, *Ji casesuchperson "" "" to this report
of Name& Surname (alsomaiden Deceased name of womanwho has if married, known)
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Date of Death

Placeof Death & (Latitude if Longitude at sea)

Sex

Dateof Birth(if known) or age

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This reportwas madeto me at the date and placeshownhereunder of Signature officer Title of officer

Date

Surname Name, & Nationality

of Signature and/or Father* at UsualResidence and Surname Maidensurname of Mother the child Marriageif different

rank Occupation, or profession

Usual at residence Death timeof

Nationality

Cause of Death*

RETIPED T'ACFIEP

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C A R D I O V A S C U i A RF A IL O ? E

* Certifiedcorrectby shiP's doctoror otherMedical (wherepossible) Practioner Certificate to be signed by the Master, or other person making the report.

and are in the and that I certify to the bestof my knowledge belief particulars this report correct true. Signature
(Masteretc) Qualification

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Date Address
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( MSF4606 RBD R e v8 / 0 7

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Additional particulars in respect of deceasedmemberof the crew, if known: Name

and Relationship Address of next of kin book No. Discharge

Date Place sectionof the OfficialLog in relatingto deathappearing the narrative Copyof entryor entries Bookor otherofficialrecord. Dateand hourof the occurrence Placeof the occurrence by or situation Latitude at and Longitude sea

Dateof entry

Narration