SENDER INFORMATION
	Tick if willing to be named as source of this information
Name of Observer/Reporter
Name of ship or Office
Sex	Male Female
IMO Number
Address of sender
E-mail Address
Telephone/Mobile No.

Instruction
Subject
General Locality
Position
Position fixing system used			Datum
Charts affected			Edition
ENCs affected
Latest Notice to Mariners held
Nautical Publications affected (Edition No.)
Details of anomaly or observation