RETAINER AGREEMENT

Know All Men By These Presents:

That I __________________________________ do solemnly give exclusive right, legal

authority and representation to Atty. EMMANUEL E. SANDICHO, with office address at 2nd
Flr. BCIS&SEC Learning Center, 117 P. Guevarra St., Santa Cruz, Laguna to act as my
exclusive retained attorney and counsel in connection with the collection, filing, pursuit
and receipt of my claims for disability, medical and other occupational benefits as a seafarer
collectible from and against the manning agents, principals, vessels, vessel owners, vessel
operators/charterer, P&I Clubs and agents/ correspondents, insurance companies and any
other persons or entities acting as representatives or assignees of employer or its principals
covered by my employment contract as hereunder specified:

Local Employer – Manning Agent: _________________________________________________

Foreign Principal/Int’l. Employer: __________________________________________________
Name of Vessel: _____________________________________ Flag:_________________________
Date of Contract: ___________________________________ Duration: ____________________

In the pursuit of my claims for disability, medical and other benefits, I further grant
exclusive authority of representation to Atty. Emmanuel E. Sandicho in the filing and
prosecution of case/s to be commenced and instituted at the National Conciliation and
Mediation Board (NCMB) and/or the National Labor Relations Commission (NLRC) at all
stages thereof, from the sala of the Labor Arbiter (or Med-Arbiter), the Commission (NLRC
or NCMB), the Court of Appeals and the Supreme Court.

This retainer agreement serves as irrevocable authority of Atty. Emmanuel E.

Sandicho to act in any manner both proper and necessary hereto. Provided that Atty.
Sandicho shall deliver to me the proceeds of the claim after deducting by him the amount
equivalent to _______% thereof as professional fee, as well as all expenses incurred in the
case or attached therewith, to which he is hereby expressly declared as being authorized
and entitled to receive and/or withhold for his disposition.

I hereby exclusively bestow upon Atty. Emmanuel E. Sandicho these authorities and
duties with full power of substitution or designation of associates and assistants by him.
And I hereby AFFIRM and RATIFY all my said attorney and counsel shall cause to be done in
connection herewith with all the force and effect of a binding civil act as if I myself am
personally present and doing so by these presents.

IN WITNESS WHEREFORE, I hereto affixed my signature this ______________ 2011 in

_________________ Philippines.

____________________________
Principal
Conformé:

Atty. EMMANUEL SANDICHO

Attorney

Signed in the presence of –

____________________________ ____________________________

ACKNOWLEDGMENT

BEFORE ME, a notary public for the province/city of ______________________, personally

appeared _________________________________ with I.D. _____________________________, issued at
____________ on ______________; known to me to be the same person who executed the
foregoing instrument, and he/she acknowledged to me that the same is his/her free and
voluntary act and deed.

Doc. No. _______;

Page No. _______:
Book No. _______;
Series of 2011.