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乗 組 員 名 簿

CREW LIST

到着
X Arrival

Departure
Page No. 1of 1
1. 船舶の名称 2. 到着港/出発港 3. 到着日/出発日
Name of ship Port of arrival/departure Date of arrival /departure

M.V. POLARIS ACE HIGASHI-HARIMA, JAPAN


4. 船舶の国籍 5. 前寄港地※ 6. 身分証明書(乗員手帳)の種類、
Nationality of ship Port arrived from※   及び番号、有効期限
Panama KWANGYANG, S.KOREA Nature and No. of identity document
7. 番号  8. 氏名 9. 職名 10. 国籍 11. 生年月日、出生地※、性別 (seaman's / passport)
No. Family name, given names, Middle name Rank or rating Nationality DOB, POB※ Sex Nature No. expiry date

1 PAGARAN, NERIO, ACAPULCO Master Filipino 23-Apr-66 G. Hernandez, Bohol M P/P EB3575138 05-Sep-2016
2 ESTOPIA, MARK BRIAN, ASENIERO C/O Filipino 9-Aug-79 Molave, Zam DS M P/P EC0154035 28-Jan-2019
3 AGDA, ARNEL, DEMIAR 2/O Filipino 25-Nov-74 Sipalay Neg Oc M P/P EB2369938 06-May-2016
4 CORBITA, BRANDON 3/O Filipino 28-Apr-79 Tubigon, Bohol M P/P EB8073630 08-May-2018
5 GWAG, BYEONG WOO C/E Korean 16-Jun-55 Busan, S.Korea M P/P M09045748 19-Mar-2019
6 SONLIT, ALBERTO, ROSALES 1AE Filipino 9-Aug-78 Pamplona, Neg Or M P/P EC4657381 14-Jul-2020
7 ALANES, RONIE, SELARIO 2A/E Filipino 13-Aug-74 Pototan, Iloilo M P/P EC1330853 04-Jun-2019
8 MANLANGIT, RAYMAN, ESPANOLA 3A/E Filipino 1-Jul-73 San Enrique N Oc M P/P EB9055665 03-Sep-2018
9 RAMIREZ, ANGELITO, SARMIENTO R/O Filipino 18-May-72 Caloocan City M P/P EC0035510 16-Jan-2019
10 CORDA, ALAN, DOLOGUIN BSN Filipino 10-Mar-75 L Jaena Mis Oc M P/P EC2637819 04-Nov-2019
11 GARCIA, NOLWEN, MARANAN A/B Filipino 11-Oct-88 Tuy Batangas M P/P EB7753208 26-Mar-2018
12 CANONCE, BRYAN, MAGPAYO A/B Filipino 23-Jan-92 Legaspi City M P/P EC4930034 06-Aug-2020
13 FABRA, JOMERZON, SENORAN A/B Filipino 25-Jul-88 Calubian, Leyte M P/P EB4810356 26-Feb-2017
14 CATAHAN, ARVIN CHESTER, DE LEON O/S Filipino 25-Jan-92 Macabebe, Pampanga M P/P EC3377412 04-Feb-2020
15 SABADO, JEROME, CATAPIA O/S Filipino 11-Jan-93 Balanga, Bataan M P/P EB6403216 23-Sep-2017
16 CANETE, ARIEL, TAN OLR-1 Filipino 3-Jan-72 Iligan City M P/P EB7120693 09-Jan-2018
17 LLARENAS, MARK DEN, ABENES OLR Filipino 15-Jun-89 Baguio City M P/P EB8674587 14-Jul-2018
18 CUEVAS, KAWASAKI, ROLUNA OLR Filipino 1-Jul-84 Maripipi, Leyte M P/P EB7015049 25-Dec-2017
19 MENESES, CARLO JASON, DELA CRUZ WPR Filipino 20-Aug-91 Mapandan Pgn M P/P EC3760087 22-Mar-2020
20 DE CASTRO, JOHN EDEL, CRUZADO E/CADET Filipino 7-Dec-93 Naic Cavite M P/P EB9224902 24-Sep-2018
21 TOLENTINO, JOSEPH, SEVERINO C/CK Filipino 3-Nov-75 Quezon City M P/P EB4658888 07-Feb-2017
22 SENERES, JOHN PAUL, SAMSON Messman Filipino 28-Oct-93 Silay City M P/P EC1566576 06-Jul-2019
12 日付及び船長又は委任を受けた代理人若しくは船舶の職員による署名
Date and signature by master, authorized agent or officer

Date: Capt. Nerio A. Pagaran


Master M.V. POLARIS ACE
(注)  ※の付されている項目については記入不要。
Note  It is not necessary to fill in the item marked “※”.
乗 組 員 名 簿
CREW LIST

到着
X Arrival

Departure
Page No. 1of 1
1. 船舶の名称 2. 到着港/出発港 3. 到着日/出発日
Name of ship Port of arrival/departure Date of arrival /departure

M.V. POLARIS ACE HIROSHIMA, JAPAN


4. 船舶の国籍 5. 前寄港地※ 6. 身分証明書(乗員手帳)の種類、
Nationality of ship Port arrived from※   及び番号、有効期限
Panama HIGASHI-HARIMA, JAPAN Nature and No. of identity document
7. 番号  8. 氏名 9. 職名 10. 国籍 11. 生年月日、出生地※、性別 (seaman's / passport)
No. Family name, given names, Middle name Rank or rating Nationality DOB, POB※ Sex Nature No. expiry date

1 PAGARAN, NERIO, ACAPULCO Master Filipino 23-Apr-66 G. Hernandez, Bohol M P/P EB3575138 05-Sep-2016
2 ESTOPIA, MARK BRIAN, ASENIERO C/O Filipino 9-Aug-79 Molave, Zam DS M P/P EC0154035 28-Jan-2019
3 AGDA, ARNEL, DEMIAR 2/O Filipino 25-Nov-74 Sipalay Neg Oc M P/P EB2369938 06-May-2016
4 CORBITA, BRANDON 3/O Filipino 28-Apr-79 Tubigon, Bohol M P/P EB8073630 08-May-2018
5 GWAG, BYEONG WOO C/E Korean 16-Jun-55 Busan, S.Korea M P/P M09045748 19-Mar-2019
6 SONLIT, ALBERTO, ROSALES 1AE Filipino 9-Aug-78 Pamplona, Neg Or M P/P EC4657381 14-Jul-2020
7 ALANES, RONIE, SELARIO 2A/E Filipino 13-Aug-74 Pototan, Iloilo M P/P EC1330853 04-Jun-2019
8 MANLANGIT, RAYMAN, ESPANOLA 3A/E Filipino 1-Jul-73 San Enrique N Oc M P/P EB9055665 03-Sep-2018
9 RAMIREZ, ANGELITO, SARMIENTO R/O Filipino 18-May-72 Caloocan City M P/P EC0035510 16-Jan-2019
10 CORDA, ALAN, DOLOGUIN BSN Filipino 10-Mar-75 L Jaena Mis Oc M P/P EC2637819 04-Nov-2019
11 GARCIA, NOLWEN, MARANAN A/B Filipino 11-Oct-88 Tuy Batangas M P/P EB7753208 26-Mar-2018
12 CANONCE, BRYAN, MAGPAYO A/B Filipino 23-Jan-92 Legaspi City M P/P EC4930034 06-Aug-2020
13 FABRA, JOMERZON, SENORAN A/B Filipino 25-Jul-88 Calubian, Leyte M P/P EB4810356 26-Feb-2017
14 CATAHAN, ARVIN CHESTER, DE LEON O/S Filipino 25-Jan-92 Macabebe, Pampanga M P/P EC3377412 04-Feb-2020
15 SABADO, JEROME, CATAPIA O/S Filipino 11-Jan-93 Balanga, Bataan M P/P EB6403216 23-Sep-2017
16 CANETE, ARIEL, TAN OLR-1 Filipino 3-Jan-72 Iligan City M P/P EB7120693 09-Jan-2018
17 LLARENAS, MARK DEN, ABENES OLR Filipino 15-Jun-89 Baguio City M P/P EB8674587 14-Jul-2018
18 CUEVAS, KAWASAKI, ROLUNA OLR Filipino 1-Jul-84 Maripipi, Leyte M P/P EB7015049 25-Dec-2017
19 MENESES, CARLO JASON, DELA CRUZ WPR Filipino 20-Aug-91 Mapandan Pgn M P/P EC3760087 22-Mar-2020
20 DE CASTRO, JOHN EDEL, CRUZADO E/CADET Filipino 7-Dec-93 Naic Cavite M P/P EB9224902 24-Sep-2018
21 TOLENTINO, JOSEPH, SEVERINO C/CK Filipino 3-Nov-75 Quezon City M P/P EB4658888 07-Feb-2017
22 SENERES, JOHN PAUL, SAMSON Messman Filipino 28-Oct-93 Silay City M P/P EC1566576 06-Jul-2019
12 日付及び船長又は委任を受けた代理人若しくは船舶の職員による署名
Date and signature by master, authorized agent or officer

Date: Capt. Nerio A. Pagaran


Master M.V. POLARIS ACE
(注)  ※の付されている項目については記入不要。
Note  It is not necessary to fill in the item marked “※”.
乗 組 員 名 簿
CREW LIST

到着
X Arrival

Departure
Page No. 1of 1
1. 船舶の名称 2. 到着港/出発港 3. 到着日/出発日
Name of ship Port of arrival/departure Date of arrival /departure

M.V. POLARIS ACE OMAEZAKI, JAPAN


4. 船舶の国籍 5. 前寄港地※ 6. 身分証明書(乗員手帳)の種類、
Nationality of ship Port arrived from※   及び番号、有効期限
Panama HIROSHIMA, JAPAN Nature and No. of identity document
7. 番号  8. 氏名 9. 職名 10. 国籍 11. 生年月日、出生地※、性別 (seaman's / passport)
No. Family name, given names, Middle name Rank or rating Nationality DOB, POB※ Sex Nature No. expiry date

1 PAGARAN, NERIO, ACAPULCO Master Filipino 23-Apr-66 G. Hernandez, Bohol M P/P EB3575138 05-Sep-2016
2 ESTOPIA, MARK BRIAN, ASENIERO C/O Filipino 9-Aug-79 Molave, Zam DS M P/P EC0154035 28-Jan-2019
3 AGDA, ARNEL, DEMIAR 2/O Filipino 25-Nov-74 Sipalay Neg Oc M P/P EB2369938 06-May-2016
4 CORBITA, BRANDON 3/O Filipino 28-Apr-79 Tubigon, Bohol M P/P EB8073630 08-May-2018
5 GWAG, BYEONG WOO C/E Korean 16-Jun-55 Busan, S.Korea M P/P M09045748 19-Mar-2019
6 SONLIT, ALBERTO, ROSALES 1AE Filipino 9-Aug-78 Pamplona, Neg Or M P/P EC4657381 14-Jul-2020
7 ALANES, RONIE, SELARIO 2A/E Filipino 13-Aug-74 Pototan, Iloilo M P/P EC1330853 04-Jun-2019
8 MANLANGIT, RAYMAN, ESPANOLA 3A/E Filipino 1-Jul-73 San Enrique N Oc M P/P EB9055665 03-Sep-2018
9 RAMIREZ, ANGELITO, SARMIENTO R/O Filipino 18-May-72 Caloocan City M P/P EC0035510 16-Jan-2019
10 CORDA, ALAN, DOLOGUIN BSN Filipino 10-Mar-75 L Jaena Mis Oc M P/P EC2637819 04-Nov-2019
11 GARCIA, NOLWEN, MARANAN A/B Filipino 11-Oct-88 Tuy Batangas M P/P EB7753208 26-Mar-2018
12 CANONCE, BRYAN, MAGPAYO A/B Filipino 23-Jan-92 Legaspi City M P/P EC4930034 06-Aug-2020
13 FABRA, JOMERZON, SENORAN A/B Filipino 25-Jul-88 Calubian, Leyte M P/P EB4810356 26-Feb-2017
14 CATAHAN, ARVIN CHESTER, DE LEON O/S Filipino 25-Jan-92 Macabebe, Pampanga M P/P EC3377412 04-Feb-2020
15 SABADO, JEROME, CATAPIA O/S Filipino 11-Jan-93 Balanga, Bataan M P/P EB6403216 23-Sep-2017
16 CANETE, ARIEL, TAN OLR-1 Filipino 3-Jan-72 Iligan City M P/P EB7120693 09-Jan-2018
17 LLARENAS, MARK DEN, ABENES OLR Filipino 15-Jun-89 Baguio City M P/P EB8674587 14-Jul-2018
18 CUEVAS, KAWASAKI, ROLUNA OLR Filipino 1-Jul-84 Maripipi, Leyte M P/P EB7015049 25-Dec-2017
19 MENESES, CARLO JASON, DELA CRUZ WPR Filipino 20-Aug-91 Mapandan Pgn M P/P EC3760087 22-Mar-2020
20 DE CASTRO, JOHN EDEL, CRUZADO E/CADET Filipino 7-Dec-93 Naic Cavite M P/P EB9224902 24-Sep-2018
21 TOLENTINO, JOSEPH, SEVERINO C/CK Filipino 3-Nov-75 Quezon City M P/P EB4658888 07-Feb-2017
22 SENERES, JOHN PAUL, SAMSON Messman Filipino 28-Oct-93 Silay City M P/P EC1566576 06-Jul-2019
12 日付及び船長又は委任を受けた代理人若しくは船舶の職員による署名
Date and signature by master, authorized agent or officer

Date: Capt. Nerio A. Pagaran


Master M.V. POLARIS ACE
(注)  ※の付されている項目については記入不要。
Note  It is not necessary to fill in the item marked “※”.
乗 組 員 名 簿
CREW LIST

到着
X Arrival

Departure
Page No. 1of 1
1. 船舶の名称 2. 到着港/出発港 3. 到着日/出発日
Name of ship Port of arrival/departure Date of arrival /departure

M.V. POLARIS ACE YOKOHAMA, JAPAN


4. 船舶の国籍 5. 前寄港地※ 6. 身分証明書(乗員手帳)の種類、
Nationality of ship Port arrived from※   及び番号、有効期限
Panama OMAEZAKI, JAPAN Nature and No. of identity document
7. 番号  8. 氏名 9. 職名 10. 国籍 11. 生年月日、出生地※、性別 (seaman's / passport)
No. Family name, given names, Middle name Rank or rating Nationality DOB, POB※ Sex Nature No. expiry date

1 PAGARAN, NERIO, ACAPULCO Master Filipino 23-Apr-66 G. Hernandez, Bohol M P/P EB3575138 05-Sep-2016
2 ESTOPIA, MARK BRIAN, ASENIERO C/O Filipino 9-Aug-79 Molave, Zam DS M P/P EC0154035 28-Jan-2019
3 AGDA, ARNEL, DEMIAR 2/O Filipino 25-Nov-74 Sipalay Neg Oc M P/P EB2369938 06-May-2016
4 CORBITA, BRANDON 3/O Filipino 28-Apr-79 Tubigon, Bohol M P/P EB8073630 08-May-2018
5 GWAG, BYEONG WOO C/E Korean 16-Jun-55 Busan, S.Korea M P/P M09045748 19-Mar-2019
6 SONLIT, ALBERTO, ROSALES 1AE Filipino 9-Aug-78 Pamplona, Neg Or M P/P EC4657381 14-Jul-2020
7 ALANES, RONIE, SELARIO 2A/E Filipino 13-Aug-74 Pototan, Iloilo M P/P EC1330853 04-Jun-2019
8 MANLANGIT, RAYMAN, ESPANOLA 3A/E Filipino 1-Jul-73 San Enrique N Oc M P/P EB9055665 03-Sep-2018
9 RAMIREZ, ANGELITO, SARMIENTO R/O Filipino 18-May-72 Caloocan City M P/P EC0035510 16-Jan-2019
10 CORDA, ALAN, DOLOGUIN BSN Filipino 10-Mar-75 L Jaena Mis Oc M P/P EC2637819 04-Nov-2019
11 GARCIA, NOLWEN, MARANAN A/B Filipino 11-Oct-88 Tuy Batangas M P/P EB7753208 26-Mar-2018
12 CANONCE, BRYAN, MAGPAYO A/B Filipino 23-Jan-92 Legaspi City M P/P EC4930034 06-Aug-2020
13 FABRA, JOMERZON, SENORAN A/B Filipino 25-Jul-88 Calubian, Leyte M P/P EB4810356 26-Feb-2017
14 CATAHAN, ARVIN CHESTER, DE LEON O/S Filipino 25-Jan-92 Macabebe, Pampanga M P/P EC3377412 04-Feb-2020
15 SABADO, JEROME, CATAPIA O/S Filipino 11-Jan-93 Balanga, Bataan M P/P EB6403216 23-Sep-2017
16 CANETE, ARIEL, TAN OLR-1 Filipino 3-Jan-72 Iligan City M P/P EB7120693 09-Jan-2018
17 LLARENAS, MARK DEN, ABENES OLR Filipino 15-Jun-89 Baguio City M P/P EB8674587 14-Jul-2018
18 CUEVAS, KAWASAKI, ROLUNA OLR Filipino 1-Jul-84 Maripipi, Leyte M P/P EB7015049 25-Dec-2017
19 MENESES, CARLO JASON, DELA CRUZ WPR Filipino 20-Aug-91 Mapandan Pgn M P/P EC3760087 22-Mar-2020
20 DE CASTRO, JOHN EDEL, CRUZADO E/CADET Filipino 7-Dec-93 Naic Cavite M P/P EB9224902 24-Sep-2018
21 TOLENTINO, JOSEPH, SEVERINO C/CK Filipino 3-Nov-75 Quezon City M P/P EB4658888 07-Feb-2017
22 SENERES, JOHN PAUL, SAMSON Messman Filipino 28-Oct-93 Silay City M P/P EC1566576 06-Jul-2019
12 日付及び船長又は委任を受けた代理人若しくは船舶の職員による署名
Date and signature by master, authorized agent or officer

Date: Capt. Nerio A. Pagaran


Master M.V. POLARIS ACE
(注)  ※の付されている項目については記入不要。
Note  It is not necessary to fill in the item marked “※”.
乗 組 員 名 簿
CREW LIST

到着
X Arrival

Departure
Page No. 1of 1
1. 船舶の名称 2. 到着港/出発港 3. 到着日/出発日
Name of ship Port of arrival/departure Date of arrival /departure

4. 船舶の国籍 5. 前寄港地※ 6. 身分証明書(乗員手帳)の種類、


Nationality of ship Port arrived from※   及び番号、有効期限
Nature and No. of identity document
7. 番号  8. 氏名 9. 職名 10. 国籍 11. 生年月日、出生地※、性別 (seaman's / passport)
No. Family name, given names, Middle name Rank or rating Nationality DOB, POB※ Sex Nature No. expiry date

1 PAGARAN, NERIO, ACAPULCO Master Filipino 23-Apr-66 G. Hernandez, Bohol M P/P EB3575138 05-Sep-2016
2 ESTOPIA, MARK BRIAN, ASENIERO C/O Filipino 9-Aug-79 Molave, Zam DS M P/P EC0154035 28-Jan-2019
3 AGDA, ARNEL, DEMIAR 2/O Filipino 25-Nov-74 Sipalay Neg Oc M P/P EB2369938 06-May-2016
4 CORBITA, BRANDON 3/O Filipino 28-Apr-79 Tubigon, Bohol M P/P EB8073630 08-May-2018
5 GWAG, BYEONG WOO C/E Korean 16-Jun-55 Busan, S.Korea M P/P M09045748 19-Mar-2019
6 SONLIT, ALBERTO, ROSALES 1AE Filipino 9-Aug-78 Pamplona, Neg Or M P/P EC4657381 14-Jul-2020
7 ALANES, RONIE, SELARIO 2A/E Filipino 13-Aug-74 Pototan, Iloilo M P/P EC1330853 04-Jun-2019
8 MANLANGIT, RAYMAN, ESPANOLA 3A/E Filipino 1-Jul-73 San Enrique N Oc M P/P EB9055665 03-Sep-2018
9 RAMIREZ, ANGELITO, SARMIENTO R/O Filipino 18-May-72 Caloocan City M P/P EC0035510 16-Jan-2019
10 CORDA, ALAN, DOLOGUIN BSN Filipino 10-Mar-75 L Jaena Mis Oc M P/P EC2637819 04-Nov-2019
11 GARCIA, NOLWEN, MARANAN A/B Filipino 11-Oct-88 Tuy Batangas M P/P EB7753208 26-Mar-2018
12 CANONCE, BRYAN, MAGPAYO A/B Filipino 23-Jan-92 Legaspi City M P/P EC4930034 06-Aug-2020
13 FABRA, JOMERZON, SENORAN A/B Filipino 25-Jul-88 Calubian, Leyte M P/P EB4810356 26-Feb-2017
14 CATAHAN, ARVIN CHESTER, DE LEON O/S Filipino 25-Jan-92 Macabebe, Pampanga M P/P EC3377412 04-Feb-2020
15 SABADO, JEROME, CATAPIA O/S Filipino 11-Jan-93 Balanga, Bataan M P/P EB6403216 23-Sep-2017
16 CANETE, ARIEL, TAN OLR-1 Filipino 3-Jan-72 Iligan City M P/P EB7120693 09-Jan-2018
17 LLARENAS, MARK DEN, ABENES OLR Filipino 15-Jun-89 Baguio City M P/P EB8674587 14-Jul-2018
18 CUEVAS, KAWASAKI, ROLUNA OLR Filipino 1-Jul-84 Maripipi, Leyte M P/P EB7015049 25-Dec-2017
19 MENESES, CARLO JASON, DELA CRUZ WPR Filipino 20-Aug-91 Mapandan Pgn M P/P EC3760087 22-Mar-2020
20 DE CASTRO, JOHN EDEL, CRUZADO E/CADET Filipino 7-Dec-93 Naic Cavite M P/P EB9224902 24-Sep-2018
21 TOLENTINO, JOSEPH, SEVERINO C/CK Filipino 3-Nov-75 Quezon City M P/P EB4658888 07-Feb-2017
22 SENERES, JOHN PAUL, SAMSON Messman Filipino 28-Oct-93 Silay City M P/P EC1566576 06-Jul-2019
12 日付及び船長又は委任を受けた代理人若しくは船舶の職員による署名
Date and signature by master, authorized agent or officer

Date:
Master
(注)  ※の付されている項目については記入不要。
Note  It is not necessary to fill in the item marked “※”.

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