WAIVER TO UNDERGO POLYGRAPH EXAMINATION

DATE: June 17, 2023

I, REYMARK PATNAAN, with a current address at Brgy. Samoki, Bontoc,

Mountain Province, of legal age is willing to undergo Polygraph
Examination to be conducted by the MPSPC-Criminology Department. That
the process of undergoing polygraph examination was explained to me and
that I understand it clearly. The result of the examination can be given to
any authorized persons.

I am willing to undergo Polygraph Examination on my own FREE WILL. That

I do not have any Health Problems, Physical or Mental that can void the
result of such examination.

I will not file charges, Criminal and/or Civil, against anybody because of the
result of the examination.

Time: 10:40 am

REYMARK PATNA-AN
Name and Signature of the Subject

Witness:
Cindy S. Sawey

Kinie Jaynes Agageo

Name and Signature of Examiner

I am proving that I have undergone the Polygraph Examination on my own

FREE WILL, even though they have explained to me that I can stop the
examination anytime, by affixing my signature below.

Time: 11:10 am

REYMARK PATNA-AN
Name and Signature of the Subject