Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS
MANILA

OATH OF MASTER COVERING LIST OF OFFICERS AND MEMBERS ON COASTWISE VESSE

Officer of the vessel known as the; M/V F & S OUR MOTHER OF PERPETUAL HELP
Clearing the port of : _____________________________________
Gross tonnage: _____133.80_____ Net Tonnage: __________67.70_____________
Coastwise License Expires on: ______OCT.24.2017__________________________
PSSC/CSSC Expires on: _________________________________________________
Total Numbers of crew(s): __________20__________________________________
Master/Patron: ______ARIEL ZURITA & ISAGANI VIANA____________________
Chief Engineer: ______PRIMITIVO CUSTUDIO______________________________

CREW MEMBERS
No Name Age Nationality Position
1 EDGARDO DELOCADO 42 FILIPINO BUSON
2 CLIFFORD VALDELEON 36 FILIPINO PURSER
3 RAY CHARLES JULATON 25 FILIPINO COORDINATOR
4 ARVIC DE LARA 28 FILIPINO COORDINATOR
5 ERWIN VALOIS 28 FILIPINO AB
6 ARNOLD TENDEDO 45 FILIPINO AB
7 EDWIN ZURITA 40 FILIPINO AB
8 DIBETH CAYETANO 38 FILIPINO AB
9 EDWARD EMEN 27 FILIPINO OILER
10 ROLAND CANIMO 28 FILIPINO OILER
11 JAY ARR SOLON 26 FILIPINO OILER
12 BERNARD ARRAGA 28 FILIPINO OILER
13 DOODY PAULINO 20 FILIPINO CADETH
14 REGIE DUMAGAN 21 FILIPINO CADETH
15 JELMER D. VIANA 21 FILIPINO CADETH
16 MARK CHE PIASAN 20 FILIPINO CADETH
17 KENJIE GREGOR 23 FILIPINO CADETH

I ____A. ZURITA__________ Master of the M/V OUR MOTHER OF PERPETUAL HELP_______ So SOLEMNLY SWEAR
THAT THE ABOVE STATEMENT IS TRUE TO THEIR BEST OF MY KNOWLEDGE AND BELIEF, that the
officers mentioned above have agreed to act in several capacities and if any changes in personnel of this
vessel. I will report the same to the Collector of Customs before sailing.

___________________________
(Master/Patron)
SUBSCRIBE AND SWORN to before me this _____day of______________20____________
at_________________ Philippines.

______________________________________________________________
(Empower to administer oath under the provissions of Sec 21 Art 255)
ppines
ce
MS

AND MEMBERS ON COASTWISE VESSEL

Residence
LUBANG OCC. MINDORO
LUBANG OCC. MINDORO
LUBANG OCC. MINDORO
LUBANG OCC. MINDORO
QUEZON PROV.
LUBANG OCC. MINDORO
LOOC OCC. MIDNORO
LOOC OCC. MIDNORO
SAN JOSE CITY
QUEZON PROV.
MASBATE CITY
PALAWAN
CEBU CITY
CEBU CITY
LUBANG OCC. MINDORO
CEBU CITY
LUBANG OCC. MINDORO

ETUAL HELP_______ So SOLEMNLY SWEAR

OWLEDGE AND BELIEF, that the
ties and if any changes in personnel of this
s before sailing.

____________________
Master/Patron)
________20____________

_______________________________________
ath under the provissions of Sec 21 Art 255)