NOTE OF PROTEST
I, ________ (name) Master Mariner and Commander of the M/V ______ (nationality of vessel), of gross and _ net registered tons, under _ flag, registered at _ by Official Number now laying at (anchor/berth No___ ) in the port of _ where she arrived on this day of_ in the year 19 __, solemnly declare that, On the (date) the said vessel, being tight, staunch and substantially and sufficiently manned and furnished with everything necessary for such a vessel and intended voyage, in every respect seaworthy, her engine and machinery in good order, her loaded cargo properly stowed, sailed from the port of _ laden with a cargo of _ (tons) of _ (name of cargo) in bulk, for delivery at this port (or at port of _______) unto Messrs _ (Cargo Receivers), and that, During the prosecution of the said voyage and on the date (here describe the accident, machinery breakdown, or heavy weather). (example of heavy weather
"on the dates of the vessel encountered heavy weather with winds of force_ and heavy seas which caused her to roll, pitch, labor and strain heavily, and waves breaking on the decks, in consideration of which fearing loss or damage to the vessel and her cargo, even though the ship's course and speed were altered to ease her according to good seamanship under the circumstances".
Whereof, I, the undersigned, hereby note my protest against all losses, damages, etc., reserving the right to extend the same at time and place convenient,
At the port of _ On the _
_____________________________
The Master of M/V
Captain