0211-09-01 Illegal or Prohibited Drugs_Substances Affidavit_ Declaration(1)

FM-CMO-MMC-0211-09-01

REPUBLIC OF THE PHILIPPNES) CITY OF MANILA……………….)S.S.

ILLEGAL OR PROHIBITED DRUGS/SUBSTANCES AFFIDAVIT/DECLARATION

I, ________________________________________, Filipino, of legal age, with residence and postal address at____________________________________________________________________________________ ______________________________________________________________, hereby depose and state that: 1. I have been hired as ________________ for the vessel __________________________________by _____________________________________________________ (Name of Principal); 2. I hereby irrevocably confirm that: a. I do not use and will not use illegal or prohibited drugs/substances. b. I will not introduce illegal or prohibited drugs/substances on board the vessel. 3. I clearly understand the following: a. Drug trafficking is a serious crime. b. The Owners and the Master of the vessel will cooperate fully with the Public Authorities in the criminal prosecution of anyone on board using and possessing illegal or prohibited drugs/substances and/or paraphernalia for the use of illegal or prohibited drugs/substances. c. I shall not be covered by the Owners P&I insurance should I commit any crime related to illegal or prohibited drugs/substances. d. I am personally responsible for all consequences (all costs, fines, charges, claims for damages, etc.) that the Owners of the vessel may face or incur as a result of my committing a crime related to illegal or prohibited drugs/substances. e. Should I commit a crime involving illegal or prohibited drugs/substances, my contract of employment shall be immediately cancelled and I shall pay and personally shoulder all repatriation costs, fines, etc. 4. I shall confirm that I have clearly read and fully understood this declaration.

________________________________ Affiant

SUBSCRIBED AND SWORN to before me, on this ____ day of _______________, _____, Affiant exhibiting to me his Passport No. _______________, issued at ______________, on ______________.

Doc. No. _____; Page No. _____; Book No. _____; Series of 20__.