Republic of the Philippines

Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO CITY

ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND

RELEASE LIABILITY AGREEMENT

IN CONSIDERATION OF MY APPLICATION, I, REYMARK S. FUENTES, hereby

acknowledge and declare the following:

1. That all the required documents/paper I have submitted relative to my application for
promotion/reclassification have been examined/reviewed by me and are true, correct
and complete in accordance with the guidelines set by the Department of Education;

2. That I am fully aware that I can be held administratively, civilly and/or criminally
liable for any misrepresentation or misstatement appearing in the supporting
documents/paper done/certified by me as correct or authentic in order to deceive or
misguide the evaluators;

3. I knowingly and freely assume all such risks, known or should have known to me,
accompanying my submission of the required documents/paper to the Department of
Education;

4. I hereby release or hold the Department of Education, its officers, officials and
employees free from any administrative, civil and/or criminal liability arising from
my submission of fictitious documents/paper or the misrepresentation or misstatement
I have made or caused to be made on the afore-mentioned required documents/paper.

I have read this ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND

RELEASE LIABILITY AGREEMENT, fully understanding its terms, and hereby sign it
freely and voluntarily without inducement.

______________________________ __________________________
(signature over printed name) Date
Applicant

Address: Elpidio Quirino Avenue, Davao City

Telephone No: (082) 224-3274, (082) 222-1672
E-mail: davao.city@deped.gov.ph