The master of every vessel arriving at any port shall give to every person shipped on board such vessel, who is entitled to his discharge, or who is discharged there, a certificate in the following form:

“A.B., one of the crew of the ship or vessel called the ________ of __________ on her voyage from ________ to ________ is hereby discharged.

Dated _____ of _______ in the year of ______

(Signed,)

C.D., Commanding said vessel.”