OSAS-SDS Form 3

Republic of the Philippines

CAVITE STATE UNIVERSITY
Cavite City Campus
Pulo, Dalahican, Cavite City

STUDENT INFORMATION

SAMONTE MARK S. M OCTOBER 1 1 1 9 9 8

Last Name First Name M.I. Sex Date of Birth

Long, Beach, Brgy. San Rafael IV, Noveleta, Cavite 2 0 1 5 1 1 3 0 4

Mailing Address Student Number
Contact Number 9 368 786 202 Academic
Name of Organization: BUSINESS MANAGEMENT Non- Academic
Performing Arts Group
Name of Adviser/s in charge: FRINZE AL A. BERNAL

PARENT / GUARDIAN PERMIT / CONSENT

This is to certify that I have full knowledge and permission for my son/daughter/foster child to join and
participate in:
Title of Activity: On-the-Job Training (OJT)
Date & Time of the Activity: June to July 2018, 8 a.m. onwards
Place of Activity:Municipal
MunicipalGovernment
GovernmentofofNoveleta
Noveleta
I concur and agree on the rules, policies & regulations being implemented by the concerned orgenizers.

MARIBEL S. SAMONTE 9357001592

Name and Signature of Parent / Guardian Contact Number

Subscribed & sworn to me this 12th day of June 2018 at Brgy. San Rafael IV, Noveleta, Cavite.