Form 11—Preliminary actForm 11—Preliminary act

## Form 11—Preliminary act (paragraph 25(2)(a)) (Title) PRELIMINARY ACT (To be used where loss of, or damage to or by, a single ship) Preliminary act of plaintiff/defendant1 1. Date of loss or damage: 2. Time of loss or damage: 3. Place of loss or damage: 4. Name of ship involved: 5. Description of anything else involved2: 6. If the ship involved belonged to the party filing this preliminary act: (a) port of registry: (b) the name of master at relevant time: (c) name and address of person in command at and immediately before the time of the loss or damage: (d) name and address of persons on the bridge at and immediately before the time of the loss or damage: (e) name and address of persons keeping a lookout at and immediately before the time of the loss or damage: (f) course, or, if the ship was stationary, heading (specify which) at the time when it first became known that there was a likelihood of the loss or damage or immediately before any measures where taken to avoid that loss or damage (whichever was the earlier): (g) speed at the earlier of the times referred to in paragraph (f): (h) alterations made to course after the earlier of the times referred to in paragraph (f) and before the time of the loss or damage, and when made: (j) alterations made to speed after the earlier of the times referred to in paragraph (f) and before the time of the loss or damage, and when made: (k) other measures taken to avoid the loss or damage, and when taken: (m) sounds or other signals given, and when given: (n) lights carried: 7. If the ship involved did not belong to the party filing this preliminary act and the loss or damage occurred in a collision with something else: (a) distance and bearing of ship at the time when its echo was first observed by radar by a person on the other thing involved in the collision: (b) distance, bearing and approximate heading of ship when first seen by a person on the other thing involved in the collision: (c) the lights that were being shown by ship when first seen by a person on the other thing involved in the collision: (d) the lights that were being shown by ship after that time but before the collision: (e) the alterations made by ship to its course after it was first seen by a person on the other thing involved in the collision, and when they were made: (f) the alterations made by ship to its speed after it was first seen by a person on the other thing involved in the collision, and when they were made: (g) the other measures taken by ship to avoid the collision, and when they were taken: (h) the sounds or other signals given by ship and when they were given: 8. The state of the weather at and immediately before the time of the loss or damage: 9. The extent of visibility at and immediately before the time of the loss or damage: 10. The state, direction and force of the tidal or other current at and immediately before the time of the loss or damage: 11. The direction and force of the wind at and immediately before the time of the loss or damage: 12. The parts of the ship and the other thing which first came into contact: 13. The approximate angle between the ship and the other thing at the moment of contact: 1. Complete all questions fully. If any are not applicable, say so and why.