WAIVER & DECLARATION

KNOW ALL MEN BY THESE PRESENTS:

I, R JADE D. UBALOBAO, of legal age, Filipino, single and a

resident of Brgy. Lawa-an Roxas City, Capiz, by these presents,
hereby state and declare that:

I am a first year student of Bachelor of Science in Chemical

Engineering, College of Engineering, Central Philippine University
(CPU), Lopez Jaena Street, Jaro, Iloilo City;

I will attend the Junior Philippine Institute of Chemical

Engineers – CPU Chapter Induction of Officers and Installation of
New Members, hosted by the JPIChE New Members, on August 3,
2019, at The Seda Atria Hotel, Donato Pison Ave, Mandurriao, Iloilo
City, with the belief that CPU through its duly authorized adviser,
teacher, staff or representative, will provide the necessary diligence
for my security and safety, and to avoid any untoward incident, loss
of life, peril, injury, or harm during my travel and participation in the
said event;

I realize the risks connected with the said activity, but I will still
go and attend the said event, because I believe that the experience
that I will derive from such participation will surely enhance my
understanding of my chosen course, moreover, it will be an essential
part of my educational training;

I declare under oath that I am psychologically, emotionally, and

physically fit to participate in the said event;

I shall not hold CPU or any of its trustee, officer, teacher,

adviser, or representative, criminally and/or civilly liable or
responsible, for my act that is contrary to law, morals or public policy,
or for any injury, damage, or loss, that I may suffer in connection with
the said training or for any accident/incident that may arise by virtue
of my own fault or negligence or of force majeure, act of God,
fortuitous event, or of any accident or incident beyond the control of
CPU, or any of its trustee, officer, teacher, adviser, or representative,
in connection with the said event;

I attest to the truth of the foregoing facts.

 IN WITNESS WHEREOF, I have hereunto affixed my signature
on this _____ day of July, 2019, at Iloilo City, Philippines.

R JADE D. UBALOBAO
Affiant

Signed in the presence of

_________________ & _______________

REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S. S.
x---------------------------------------------x

BEFORE ME, on this _____ day of July, 2019, at Iloilo City,

Philippines, personally appeared R JADE D. UBALOBAO known to
me to be the same person who executed and signed in my presence,
the foregoing Waiver & Declaration, which consists of two (2) pages,
including this page where the acknowledgment is written, duly signed
by him and his instrumental witnesses on each page hereof, and he
acknowledged to me that the same is his free and voluntary act and
deed.

R JADE D. UBALOBAO presented to me his Student Identity

Card with I.D. No. 19,-3152-92, as competent evidence of identity
under the 2004 Rules on Notarial Practice, as amended.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2019.