UNIVERSITY OF THE PHILIPPINES MANILA

College of Dentistry
Pedro Gil St. cor Taft Avenue, Manila 1000
Tel. No: (632) 5302 6387, (632) 5310 5424, (632) 5303 3603
E-mail: upm-cd@up.edu.ph
OCS Email: cdocs.upm@up.edu.ph

CONFORME

I, ____________________________________________________(print full name with first,

middle and surname) acknowledge my responsibility as a Review Class student of the UP
College of Dentistry. I will observe and be bound by its regulations concerning use of materials
and resources. I acknowledge that the College of Dentistry does not authorize the recording,
sharing/dissemination of the review materials, lectures and other resources without consent
therefore I undertake to abide by the rules of the College pertaining to conduct, study, and
examinations.

I also undertake to protect and keep the privacy of all e-reviewers, study materials, videos,
examinations and other documents given by the College or uploaded in the shared Google
Drive. Unauthorized recording, sharing or sending of such to unauthorized persons and/or
those not enrolled in the program constitute a violation of school policies that warrants
administrative sanction, without prejudice to the filing of a legal/criminal complaint pursuant to
violations of R.A. No. 10175 (The Cybercrime Prevention Act), R.A. No. 11313 (Safe Spaces
Act) and/or R.A. No. 4200 (Anti-wire Tapping Act) against me as deemed applicable and
necessary by the College or University.

I also undertake to pay the fees due to UPCD which should be paid on or before the following
dates via online banking:
Downpayment- upon enrollment
Full payment- on or before July 15, 2020 or at a date as agreed with the
Course Coordinator

My failure to pay on said dates will mean the cancellation of my registration.

By signing below and returning this document, I agree with Republic Act No. 10173, or the Data
Privacy Act of 2012, and other relevant Philippine laws including the collection, processing and
use of my personal data for purposes connected with my studies, and for other purposes of
UPCD. I also agree to the sharing of such data for the same purposes with the University. I
also confirm that the data I provided is true and correct and that UP reserves the right to revise
any decision made on the basis of the information I provide should this be found untrue or
incorrect.

This contract shall be governed and construed in accordance with Philippine Laws. By signing
and exchanging this document, I and UPCD submit to the exclusive jurisdiction of the University
of the Philippines-Manila for the resolution of any disputes which may arise out of or in
connection with the contract.

Conforme:

Name: _____________________________________ Signature: ____________________

Date: _______________
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