UNIVERSITY OF THE EAST

WAIVER
I, ________________________________ age ___________ and residing
at ____________________________________ and an applicant for the On-the-Job
Training with a cooperating industry through the request of the University of the East
and in consideration thereof, do hereby freely and accept the following duties:

1. That I recognize the authority of my cooperating company or agency where I will

be placed and submit myself to all the reasonable rules and regulations that are
imposed upon me in connection with my training, and

2. That I renounce and waive any claim against the cooperating company/agency
and the University of the East for any injury that I may sustain, or loss that I may
suffer, personal or pecuniary, in the performance of my duties or function while
under training.

Signed in the _______________, Philippines, this _______ day of _____________

20____.

_________________________
Signature of Student

Student No. ____________

WITNESS:

With this consent and approval of Parents/Guardian:

________________________ SSS/TIN/Voter’s ID No. ____________

Signature of Parent/Guardian

Address: __________________________________________________________
__________________________________________________________________

ATTESTED:

____________________________ __________________________
OJT Coordinator College Dean

**Please proceed to any Notary Public after securing the signature of the OJT Coordinator and the Dean for
notarization. Kindly bring photocopy of your school ID as a proof of Identity. **

SUBSCRIBED AND SWORN to before me this _______ day of __________ 20___ at Manila,
Philippines. Affiant having exhibited to me his/her Student ID with student number
___________________________.

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