I certify that this invoice is correct and just, that it is a correct statement of the compensation calculated in accordance with the provisions of NSA Order No. 47 due the undersigned General Agent for the month of __________ under Service Agreement No. ______ made as of ______ with the National Shipping Authority, and that payment thereof has not been received.
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Name of General Agent
_______________________________
Signature
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Title
46 C.F.R. §3