Form No.

07

REPUBLIC OF THE PHILIPPINES

IN THIS MUNICIPALIT OF AURORA) S.S.
X-------------------------------------------X

AFFIDAVIT OF WAIVER

I, ________________________________________ of legal age, Filipino citizen

single/married and with residence and postal address at
_________________________________________________ and say:

That I recognize the authority of __________________________________under

whom I may by subjected to submit to such rules and regulations that may be imposed on
me in connection with my Industry Immersion Training starting
____________________________.

That I renounce and waive any and all claims against________________________

______________________ for injuries that I may sustain or loss that I may suffer, personal
or pecuniary in the performance of my duties and functions while undergoing said Industry
Immersion Training.

That this Affidavit is being executed to establish the truth of the

_____________day of _______________ 20 ____ at the city of Pagadian, Philippines.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of

_____________________________
20 ___ at the City of Pagadian, Philippines. Affidavit exhibiting to me his
Residence Certificate No. ________________ issued on____________________
at ______________
___________________.

_____________________
NOTARY PUBLIC

Doc. No. : ___________

Page No. : ___________
Book No. : ___________
Series No. : ___________