UNDERTAKING AND WAIVER

(For ALS Enrollees)

I, ____________________________________, of legal age/(with my parental consent) presently

residing at ______________________________________________, after having been duly
sworn to in accordance with the law, do hereby depose and say that:

1. I have been admitted at MARY THE QUEEN COLLEGE OF QUEZON

CITY (MQCQC) for enrollment in the Alternative Learning System (ALS) with
Basic Education/ Senior High for School Year _______________;

2. I have been recommended by my teacher and/or adviser from my former school

___________________________________________ (name of school) whose
signature appears below before finally being admitted here at the MQCQC;

3. I fully understand that I shall only claim and receive the pledged freebies worth
P1,000 upon the completion and full compliance of the QVR to the Department
of Education in order for the MQCQC to facilitate my outstanding billing process;

4. This undertaking and waiver is being executed to attest to the truth of the
foregoing, and for all legal intent and purposes.

AFFIANT FURTHER SAYETH NAUGHT.

___________________________
Affiant

With my Parent’s/Guardian’s consent: Teacher/Adviser’s recommendation:

___________________________________ ________________________________
(Signature over printed name) (Signature over printed name)

SUBSCRIBED AND SWORN to before me on ________ 2023 in _______ City,

affiant exhibiting to me his/her competent proof of identity consisting of his/her
__________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of 2023