Republic of the Philippines

City of Manila )SS.

A F F I D A V I T--W A I V E R
I, ____________________________with address at ___________________________,
after having been duly sworn to in accordance with law, depose and say:

1. That I am applying for admission as a University Entrance Artist of the

University Center for Culture and the Arts, of the Polytechnic University of the
Philippines, Sta. Mesa, Manila.

2. That I have read all the rules and conditions applicable to a University Entrance
Artist and shall commit myself devotedly to the UNIVERSITY and continuously
possess good moral character as determined by the Director, University Center for
Culture and the Arts;

3. That I shall commit myself to be in good academic standing by maintaining a

grade of 3.0, without failure, withdrawn or incomplete grades for a period of two
(2) years (4 semesters) starting June 2007;

4. Failure on my part to abide and comply with this agreement, shall mean forfeiture
of all the benefits and privileges accorded to me by the University Center for
Culture and the Arts including my dismissal, suspension or withdrawal from the
University and forever waive all my rights in connection with my enrolment with
the University.

5. That this affidavit is being executed to attest to the truth of the foregoing and for
the purpose of compliance with its entirety and I freely and voluntarily assume all
my responsibilities as explained to me and understood in a language known to me
without threat or intimidations.

IN WITNESS WHEREOF, I have hereunto set my hand on this ___day of ______,2007

at the City of manila, Philippines.

_______________________
Print Name and Signature
Affiant

I hereby agree and consent to the foregoing agreement:

________________________
Signature of Parent/Guardian

SUBSCRIBED AND SWORN to before me this _____day of _____year_____.

Affiant exhibited to me his/her Community Tax Certificate No. _______________
issued at ________________on __________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No.______
Series of ______