Student-Trainee’s Waiver of Liability

I, ______________________________________ bonafide student of Universidad de Manila

hereby agree on the following terms and conditions relative to my application for the
participation in the On the Job Training (OJT) program of Universidad de Manila:

1. That I shall abide by the bureau of internal revenue rules and regulations in the
implementations of its OJT Program;

2. That I shall exert care and diligence in the performance of any task that may be assigned to
me;

3. That I shall waive any claims against bureau of internal revenue and Universidad de Manila
for any injury or untoward incident that may happen to me in the performance of my duties as a
student trainee;

4. That I shall be held responsible for any damages to property or injury to third person as a
result of my intentional or negligent act while in the course of my training.

Signed on this ____________________________ day of ______________________ at

__________________________________________, Philippines.

____________________________
Student’s signature over printed name

Res. Cert. No. ________________

Issued on: ___________________
Issued at: ___________________

SUBSCRIBE AND SWORN TO BEFORE ME, this__________________________________,

20___ at ________________________________________________________, Philippines.

Doc. No. _____________

Page No. _____________
Book No. _____________
Series of ______________