REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI
) S.S.
AFFIDAVIT
That I, PERFECTO B. BALLARES of legal age, male, and with residence
address at 073 Foton St., Brgy. San Narciso, Candelaria, Zambales , after having
been duly sworn to in accordance with law do hereby depose and state:
1. That I was hired as Second Mate in the vessel M/T Delta Star by
Marsaman Manning Agency, Inc., for its principal, Delta Tankers Ltd.. I
have been with the principal for 10 years.
2. I was asked to sign a 6 month contract by Marsaman Manning for a basic
salary of USD 1079.00 a month.
3. That on September 30, 2013, I was deployed and before boarding the
vessel for Marsaman Manning Agency Inc., I underwent a Pre-employment
Medical Examination and I was issued a clean bill of health and found FIT
TO WORK.
4. That as a Second Mate, my responsibilities involved ensuring the safety and
efficient voyage of the ship. All route planning, chart and publication
corrections, bridge equipment upkeep and maintenance are also part of my
duties, as well as performing the function of a bridge watch and I am also
responsible for the navigational team.
5. That on December 2, 2013, while the ship is docking in Brazil, I helped the
AB Seamen in lifting the heavy cable wires and rope tails.
6. That as I lifted the heavy cables and ropes, I suddenly heard a snap followed
immediately by a severe sharp pain on my left lower back. That I continue
working that day and finish my duty.
7. That the cable wires and rope tails weigh more than 50 kilograms and
must be carried by at least two persons. That it was a busy day for the ship
that time and no other personnel is available to help in lifting the cable wires
and rope tails.
8. That few days after, I felt that my low back pain already radiated to my left
posterolateral thigh down to my left leg and foot. That I informed the ships
captain and he gave me pain relievers.
9. That while in US, I requested medical check up to the captain, however,
captain refused and told me that I cannot disembark for medical check-up
since I do not have a US Visa.
10.That I continued working despite suffering from back pain and difficulty in
moving.
11.That on February 28, 2014, while hte ship docked in Greece, I was referred
to a clinic where I was physically evaluated I was given an intramuscular
injection of pain reliever and was prescribed an oral pain reliever and muscle
relaxant.
12.That the medication provided to me afforded a slight relief only. That I still
continue working despite of pain.
13.That on April 30, 2014, while climbing the stairs going to ships bridge, I
suddenly felt a severe low back pain radiating down to my left thigh, leg, and
foot, and I was unable to move and walk because even a little motion of my
trunk and left lower extremity causes a severe radicular type of pain.
14.That I was confined in my cabin for a week. That on May 8, 2014, while in
Texas, I was brought to the hospital and CT scan was performed and I was
found out suffering from a slipped disc.

15.That I was certified unfit to work and was medically repatriated on May 9,
2014.
16.That on May 12, 2014, I reported to the company office for disposition and I
was referred to a company affiliated clinic for medical evaluation.
17.That I started physical therapy sessions at my own expense while waiting for
companys approval.
18.That on May 26, 2014, I was referred to an orthopedic surgeon in St. Lukes
Medical Center, Global City who evaluated me and requested for an X-ray and
MRI of my lumbosacral spine. I was advised to undergo at least six sessions of
physiotherapy prior to reevaluation.
19.That in June 10, 2014, after having noted my MRI findings, the orthopedic
surgeon advised me to undergo surgical spinal decompression. I was
advised by the company to wait for the approval of my operation. However,
on June 24, 2014, I was advised that the company did not approve my
continued treatment for reason that my condition was degenerative and not
work-related. That no further treatment was undertaken since then.
20.That at present, I still suffer from low back pain radiating down to my left
posterolateral thigh, leg, and foot. I cannot tolerate more than 30 minutes of
continuous sitting, standing, and walking as well as light to moderate
activities.
21.That my present clinical diagnosis is Chronic Low Back Pain Syndrome with
Sciatica, left secondary to nerve root compression L4-L5 level secondary to
Herniated Disc.
22.
That the negative effect of this has on my physical capacity to work in
board a sea vessel and renders me incapable to continue performing
my occupation as a seafarer safely and efficiently.
23.That I was likewise found to be partially and permanently unfit to
continue working as a seafarer.
S
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
_________ 2015 in Makati City.
PERFECTO B. BALLARES
Affiant
SUBSCRIBED AND SWORN to before me this _____ day of __________ 2015,
affiant exhibiting to me his TIN No.
Doc. No. ______:
Page No. ______:
Book No.______:
Series of 2015