Republic of the Philippines

Manila

1.0 I, ___________________________, married, Filipino of legal age, and residing

at_______________________________________________________. After having
sworn in accordance with the law hereby depose and state that:
2.0 I allow my son/daughter __________________________________________ to
participate in the On-The-Job Training program which is a requirement for the degree in
___________________________________, that will cover ______________ hours and
will be conducted in ____________________________________, located
__________________________________ from ___________________________.

We are aware that the immediate superior with the company will take necessary precautions to
keep the students safe.

However, if despite all the efforts taken, untoward incidents beyond their control occur we will not
hold ____________________________________________ as well as the company where our
daughter took the On-The-Job Training liable.

IN WITNESS THEREOF, I have hereunto affixed my signature this

___________________, in Manila.

Affiant

Subscribe and sworn to before this _______________________, affiant exhibiting to me

his competent evidence of identify, SSS/TIN/Voters ID no.:_______________________

Doc. No.:_______________
Page No.:______________
Book No.:______________
Series of 2018