REPUBLIC OF THE PHILIPPINES

____________________________SS
____________________________

AFFIDAVIT OF WAIVER
I, ________________________ of legal age, Filipino citizen, _____________ with postal
address of _____________________________________________________________ after having
been sworn to in accordance with law, hereby depose and say.
That,
I
recognize
the
authority
of
the
_______________________________________________ under whom I may be subjected to such
rules and regulations that maybe imposed on me in connection with my On-the-Job
Training
(OJT)
starting
on
_________________________________
to
________________________________.
That,
I
renounce
and
waive
any
and
all
claims
against
__________________________________ for injuries that I may suffer in the performance of my
duties and functions while undergoing said On-the-Job Training.
That, the affidavit is being executed to establish the truth of the forgoing
statement and for all legal intents and purposes this may serve.
IN WITNESS WHEREOF, I hereunto set my
_______________________ at Buug, Zamboanga Sibugay.

hand

this

________

day

of

______________________________________
Affiant
SUBSCRIBED AND SWORN to before me this ______ day of _____________________________ at
Buug, Zamboanga Sibugay, Philippines.

Notary Public

Doc No.: _________________________

Page No.: ________________________
Book No.: ________________________

Series No.: _______________________