Affidavit of Waiver FMT

AFFIDAVIT OF WAIVER
I, MAR CABANA GUZMAN of legal age, Filipino and a resident of
ZONE 5 BUGAN BAGGAO CAGAYAN after having been duly sworn to in accordance with the law do hereby depose and
say:
That I am an applicant of ERIKA CREWMANNING SERVICES INC., located at Rm. 303 and 304 Travellers
Life Bldg., 490 TM Kalaw, Ermita, Manila;
That I applied for the position of FISHERMAN trading worldwide;
That I underwent medical examination at First Medical Team Multi-Specialty & Diagnostic Center
International Medical Services located at 970 Pres. Quirino Ave., cor. Modesto St., Malate Manila on
__________________________;
That based on the medical findings by First Medical Team Multi-Specialty & Diagnostic Center International
Medical Services, I was certified as UNFIT/PENDING for Sea Duty due to following reason/s :
CHRONIC HEPATITIS B INFECTION

INACTIVE CARRIER
That this/these findings may interfere with my work efficiency, may pose possible health complications, maybe
cause for hospitalization, or I maybe simply disliked by my employer;
That I am executing this affidavit of waiver and I shall assume full responsibility for any all liabilities or damaged
arising from this particular finding including travel expenses, repatriation fines, and all other expenses and
obligation, financial or otherwise. The examining clinic First Medical Team Multi-Specialty & Diagnostic
Center International Medical Services and the agency ERIKA CREWMANNING SERVICES INC., shall not
be held liable in any way for the same;
That because of my insistence and own volition, I am still proceeding with my trip against the medical advice of
First Medical Team Multi-Specialty & Diagnostic Center International Medical Services. In this connection, I
hereby waive all my rights, privileges or any claim whatsoever to First Medical Team Multi-Specialty &
Diagnostic Center International Medical Services and ERIKA CREWMANNING SERVICES INC.;
That I release First Medical Team Multi-Specialty & Diagnostic Center International Medical Services and
ERIKA CREWMANNING SERVICES INC.; from any responsibility and liability that may arise as a
consequence of my insistence and demand to work abroad.
That I further release them from any responsibility and liability on anything that might happen to me while I am
employed onboard;
That I hereby attest to the truth and veracity of the forgoing facts;
IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

Philippines.
MAR CABANA GUZMAN

Affiant
Passport No. : P7604972B
Date Issued : 15 SEP 2021
VALIDITY : 14 SEP 2031
Place Issued : DFA TUGUEGARRAO
ure
SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Philippines, affiant having exhibited to me his/her Identification as stated above.
NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2021
AFFIDAVIT OF WAIVER
I, ROMEO ROSARIO TORLAO of legal age, Filipino and a resident of CALUBIAN LEYTE after having been duly
sworn to in accordance with the law do hereby depose and say:
That I applied for the position of MASTER trading worldwide;
International Medical Services located at 4th Flr. San Luis Terraces Bldg., 638 TM Kalaw St., Ermita Manila on
__________________________;
For Stress test+cardiac clearance to come back
arising from this particular findings including travel expenses, repatriation fines, and all other expenses and
employed onboard;

Philippines.
ROMEO ROSARIO TORLAO

Affiant
Date Issued : 08 JAN 2019
Place Issued : DFA NCR CENTRAL
Validity : 07 JAN 2029
Conforme:
___________________________other/Father of Affiant
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2020
AFFIDAVIT OF WAIVER
I, RODOLFO SALVA GALEDO of legal age, Filipino and a resident of 114M URRUTIA ST. ARKONG BATO,
VALENZUELA CITY after having been duly sworn to in accordance with the law do hereby depose and say:
That I applied for the position of MASTER trading worldwide;
__________________________;
For stress echo+cardiac clearance. to come back
employed onboard;

Philippines.
RODOLFO SALVA GALEDO

Affiant
Passport No. :
Date Issued :
Place Issued :
Validity :
Conforme:
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2020
AFFIDAVIT OF WAIVER
I, DANIEL OGALESCO LAGATA JR., of legal age, Filipino and a resident of 4K FLORES DE MAYO ST., SFDM,
QUEZON CITY after having been duly sworn to in accordance with the law do hereby depose and say:
That I applied for the position of CHIEF OFFICER trading worldwide;

__________________________;
For ECG to come back
employed onboard;

Philippines.
DANIEL OGALESCO LAGATA JR

Affiant
Date Issued : 17 SEP 2019
Place Issued : DFA NCR NORTHEAST, PHILIPPINES
Validity : 16 SEPT 2029
Conforme:
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2020
AFFIDAVIT OF WAIVER
I, MANUEL RADA SARABIA of legal age, Filipino and a resident of PUROK 5, DALIPUGA, ILIGAN CITY after
having been duly sworn to in accordance with the law do hereby depose and say:
That I applied for the position of ABLE SEAMAN trading worldwide;
International Medical Services located at 4th Flr. San Luis Terraces Bldg., 638 TM Kalaw St., Ermita Manila on 06
JULY 2020;
SARABIA, MANUEL RADA

Granubna, Right Lower Lobe
Cleared by Pulmonologist
And all its possible complications
employed onboard;

Philippines.
MANUEL RADA SARABIA

Affiant
Date Issued : 27 FEB 2020
Place Issued : CAGAYAN DE ORO, PHILIPPINES
Validity : 11 AUGUST 2025
Conforme:
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2020
AFFIDAVIT OF WAIVER
I, MARCIL, REYMARK BURLAT of legal age, Filipino and a resident of PINES OROQUIETA CITY after having
been duly sworn to in accordance with the law do hereby depose and say:
That I applied for the position of FISHERMAN trading worldwide;
DEC 2019;
CBC: Hgb:129(Low),
Hct: 0.38(Low),
For Repeat CBC after 2 weeks.
employed onboard;

Philippines.
REYMARK BURLAT MARCIL

Affiant
Passport No. :
Date Issued :
Place Issued :
Validity :
Conforme:
0.
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2019
AFFIDAVIT OF WAIVER
I, RENAN ROMASANTAQ PARREÑO of legal age, Filipino and a resident of TAWIRAN, STA. CRUZ,
MARINDUQUE after having been duly sworn to in accordance with the law do hereby depose and say:
That I applied for the position of ABLESEAMAN trading worldwide;
SEPTEMBER 2019;
MICROSCOPIC HEMATURIA – CLEARED BY NEPROLOGIST
employed onboard;

Philippines.
RENAN ROMASANTA PARREÑO

Affiant
Passport No. : P0959844A
Date Issued : 19 NOV 2016
Place Issued : DFA MANILA
Validity : 18 NOV 2021
Conforme:
Name and Signature

NOTARY PUBLIC
Doc. No. _____;

Page No._____;
Book No._____;
Series of 2019

Affidavit of Waiver FMT

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AFFIDAVIT OF WAIVER

I, MAR CABANA GUZMAN of legal age, Filipino and a resident of

That I applied for the position of FISHERMAN trading worldwide;

CHRONIC HEPATITIS B INFECTION

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

MAR CABANA GUZMAN

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of MASTER trading worldwide;

For Stress test+cardiac clearance to come back

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

ROMEO ROSARIO TORLAO

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of MASTER trading worldwide;

For stress echo+cardiac clearance. to come back

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

RODOLFO SALVA GALEDO

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of CHIEF OFFICER trading worldwide;

For ECG to come back

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

DANIEL OGALESCO LAGATA JR

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of ABLE SEAMAN trading worldwide;

SARABIA, MANUEL RADA

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

MANUEL RADA SARABIA

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of FISHERMAN trading worldwide;

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

REYMARK BURLAT MARCIL

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

That I applied for the position of ABLESEAMAN trading worldwide;

MICROSCOPIC HEMATURIA – CLEARED BY NEPROLOGIST

IN WITNESS WHEREOF, I have hereunto to sign my hands this _________________________________ at Manila,

RENAN ROMASANTA PARREÑO

SUBSCRIBED AND SWORN to before me this __________________ in the City of ___________________,

Doc. No. _____;

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