Republic of the Philippines )

Province of Antique )) S.S.

San Jose de Buenavista )
x--------------------------------------x

AFFIDAVIT

I, __________________________________, ______________years old,

Filipino, married/single/widow/widower and a resident of
_______________________________, after having been duly sworn to in accordance
with law, hereby depose and state, that:

1. I am a seafarer and is required to register at MARINA INTEGRATRED

SEAFARERS MANAGEMENT ONLINE (MISMO) SYSTEM;

2. Unfortunately however, due to inadvertence, I registered two email

addresses, _________________________ and
____________________________ at MISMO SYSTEM and is now having
difficulty accessing my accounts;

3. Also, my MARINA ID SRN was erroneously entered as

____________________ instead of _________________________;

4. I am executing this Affidavit to attest to the truth of the foregoing facts and
to request for the merger of my two (2) mismo accounts using my correct
SRN #___________________________.

IN WITNESS WHEREOF, I have hereunto set my hand this

______________day of ________________, ___________ at San Jose, Antique.

_________________________________
Affiant
ID No._________________________

SUBSCRIBED AND SWORN to before me this ______________________

at San Jose, Antique, Affiant exhibiting to me the above-indicated government issued
ID as competent proof of identity.