WAIVER

I, ________________________, of legal age, Filipino, single/married with

address at____________________________________, do hereby name, constitute
and appoint COLLEGE OF OUR LADY OF MERCY ASSESSMENT CENTER to
record the actual assessment of ______________________________________
with video and audio recording as one of the requirements for the said assessment
to be presented at the Provincial Office.
Issued on ___________________, 20____ at the ___________________________________..

____________________________
Signature of the Certified Assessee

___________________________
Authorized Representative of AC
(Signature over Printed Name)

WAIVER

I, ________________________, of legal age, Filipino, single/married with

address at____________________________________, do hereby name, constitute
and appoint COLLEGE OF OUR LADY OF MERCY ASSESSMENT CENTER to
record the actual assessment of ______________________________________
with video and audio recording as one of the requirements for the said assessment
to be presented at the Provincial Office.
Issued on ___________________, 20____ at the ___________________________________..

____________________________
Signature of the Certified Assessee

___________________________
Authorized Representative of AC
(Signature over Printed Name)