AFFIDAVIT OF WAIVER

I/We, , ( Rank / Name) of legal

age, with residence at ______________________________________after
having sworn to in accordance with the law, hereby depose and state, THAT:

1. I/We are members of Philippine National Police (PNP)assigned /

detailed with ___________________________________(Unit/Designation);

2. I/We take part in subjecting myself/ ourselves to COVID-19 Test for

my/our own account or whatever means;

3. Should I/We tested positive, I/We recognize the authority of PNP to

divulge and announce my/our covid-19 test results for its personal use and
whatever legal purpose it may serve.

IN WITNESS WHEREOF I/We have affixed my/our signature/s this

______day of ___________, 20_______in_________________.

Affiant/s

SUBSCRIBED AND SWORN to before me, this day of ______

, 20 , in Affiant exhibiting to
me his/her/their government-issued ID issued at on
, 20 .

NOTARY PUBLIC

Doc. No. ___________

Page No. ___________
Book No. ___________
Series No. __________