TIP-CC-028 Revision Status/Date: 1/2017 NOV 07

PRIVACY CONSENT

I understand and agree that by filling out this form I am allowing the Technological Institute of
the Philippines to collect, process, use, share, and disclose my personal information for internship
and also to store it as long as necessary for the fulfillment of the stated purpose and in accordance
with applicable laws, including the Data Privacy Act of 2012 and its Implementing Rules and
Regulations, and the T.I.P. Privacy Policy. The purpose and extent of collection, use, sharing,
disclosure, and storage of my personal information was explained to me.

STUDENT’S PARENT/ GUARDIAN WAIVER

(On-the-Job Training / Practicum)
This is to certify that I am allowing my son / daughter _______________________________________
(Name of Student)
to undergo On-the-Job Training/Practicum at _____________________________________________
(Name of Company)
from ______________________ to ______________________.

We also hold the Technological Institute of the Philippines free and harmless from any responsibility nor be
held liable whatsoever for any injury, personal or pecuniary, which may happen to him / her and / or caused
by third person within or outside the company premises throughout the duration of the On-the-Job
Training/Practicum.
________________________________________ ________________________________
Parent’s/Guardian’s Signature Over Printed Name Student’s Signature Over Printed Name
Date : __________________________________ Date : ___________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S

BEFORE ME, a Notary Public for and in Manila City this ________ day of ________, personally appeared:

NAME CTC NO. DATE/PLACE ISSUED

All known to me and to be known to be the same persons who executed the foregoing Memorandum of
Agreement, consisting of two (2) pages, signed by them and their witnesses, and they acknowledge that
the same is their voluntary act and deed and also of those whom they represent.

WITNESS MY HAND AND SEAL

DOC. NO. ;
PAGE NO. ;
BOOK NO. ;
SERIES NO ;
NOTARY PUBLIC