Form B

WAIVER AND RELEASE OF LIABILITY

Student’s Waiver

I, ___________________________, a student of ___________________________,

hereby waive, release, discharge CONVERGYS, its directors and officers, from any and all
claims or liability arising from any injury, loss or accidents, without any fault or
negligence on the part of CONVERGYS, that I may sustain or may suffer, whether
personal or pecuniary, as a result of my participation in the Internship Program. In
addition, I hereby hold CONVERGYS free and harmless and agree to indemnify
CONVERGYS, whenever applicable, for any damage, loss, or injury I may have caused to
persons and/or property during my participation in the Internship Program.

I acknowledge that I am aware and I have been fully informed that, as student
intern and not an employee of CONVERGYS, I am not covered by the Labor Code and
social legislations.

I acknowledge that I have read, fully understood, and voluntarily accepted this
Waiver and Release of Liability.

Signed this ___ day of MONTH, YEAR in Cebu City, Philippines.

NAME AND SIGNATURE

OF STUDENT INTERN

_______________________________
Student Intern

Parents’/Guardian’s Waiver

We, ___________________________, parents/guardian of

___________________________, a student of ___________________________ hereby waive,
release, discharge CONVERGYS, its directors and officers, from any and all claims or
liability arising from any injury, loss or accidents, without any fault or negligence on the
part of CONVERGYS, that my son/daughter/ward may sustain or may suffer, whether
personal or pecuniary, as a result of his or her participation in the Internship Program. In
addition, I hereby hold CONVERGYS free and harmless and agree to indemnify
CONVERGYS, whenever applicable, for any damage, loss, or injury my
son/daughter/ward may have caused to persons and/or property during his or her
participation in the Internship Program.

I acknowledge that I have read, fully understood, and voluntarily accepted this
Waiver and Release of Liability.

Signed this ___ day of MONTH, YEAR in Cebu City, Philippines.

NAME AND SIGNATURE OF

PARENTS/GUARDIANS

_________________________________
Student Intern’s Parents/Guardian