Republic of the Philippines )

Surigao City )
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MARINE PROTEST
I _______________, of legal age, married and a resident of
_______________, Surigao del Norte, Philippines, After being duly
sworn to in accordance with law do hereby depose and say:

1. That, I am the master of ______________, a cargo vessel owned

by ____________________;

2. That, on or about 04:00 in the morning of July 26, 2018, the

above-mentioned vessel sank off while docked at the Port of
Hayanggabon, Claver, Surigao del Norte;

3. That the caused of such unfortunate incident was the

unfavorable sea condition (rough seas, moderate to strong winds
and strong current) resulting to the slow ingress of seawater to
the engine room which lead to the sinking of the vessel;

3. That upon the happening of the same, we immediately secured

the crew on board and the cargoes as well;

4. That no oil spill was detected and no damage to the

environment was observed;

5. That, I am executing this Affidavit to to attest the truth and

veracity of the facts stated above.

IN WITNESS WHEREOF, I have hereunto set my hand this _____th

day of July 2018, at Surigao City, Philippines.

____________________
Affiant

SUBSCRIBED AND SWORN TO before me on this ___ day of

July 2018 in Surigao City, Philippines, after affiant exhibiting to me
his Voter’s Identification Card with I.D. No.
___________________________ as competent evidence of his identity.

Doc No. ____

Page No. ____
Book No. ____
Series of 2018