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Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Barangay Bagong Pag-asa, Quezon City

Date:__________

PHYSICAL AGILITY TEST WAIVER FORM

I, __________________________________________, ___________ years old,

resident of _________________________________________________ do hereby

submit myself voluntarily to undergo the Physical Agility Test (PAT), fully understand

that the BFP NCR shall not be held liable/ responsible for any injury that I may acquire

in the process.

_________________ _____________________
Witness Applicant’s Signature

BFP-QSF-HRMD-012 Rev. ØØ (05.04. 18)

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