1. On or about the day of , the defendant insured certain goods against loss or injury by the perils of the seas, and other perils in a policy of insurance from the Port of New York to the Port of Mobile, on board the bark Neptune.
2. The goods were wholly lost by the shipwreck of the vessel on her voyage, of which the defendant has had notice.
Wherefore, (etc. as in Form 3).
Ala. R. Civ. P. Form 15