BATAAN PENINSULA STATE UNIVERSITY

MAIN CAMPUS
College of Information and Communications Technology
City of Balanga, 2100 Bataan
(047) 237-2010 | www.bpsu.edu.ph | cict_mc@bpsu.edu.ph

________________________
Date

WAIVER

TO WHOM IT MAY CONCERN:

In view of my On-the-Job Training Program at

(Company Name and Address)

as partial fulfillment of the requirements of my course Bachelor of Science in Information Technology Major in Network
and Web Application.

I, a bonafide student of Bataan Peninsula State University-Main Campus,

(Name of Student)
Academic Year 2023-2024. Hereby affirm that the company herein stated is in no way responsible nor shall pay
compensation for any untoward incident that may happen during my training since I am insured under the Standard
Insurance Co. Inc. of the University.

I also certify that in my free signified my intent to undergo this training/exposure from
until the completion of 324 hours.
(Starting date)

(Signature of Parent/Guardian overprinted Name) (Signature of Trainee overprinted Name)

(Date) (Date)

SIGNED IN THE PRESENCE OF:

NOEL N. TOLENTINO
CICT OJT Coordinator

(Date)

SUBSCRIBED AND SWORN TO before me this day of , 2024 at BPSU Main Campus,
City of Balanga.

FRANK ELIE V. MORALES

Chairperson, Student Affairs & Services

Our Vision Our Mission

An inclusive and sustainable University recognized for its global To develop innovative leaders and empowered communities by delivering transformative
academic excellence by 2030. instruction, research, extension, and production through change drivers and responsive policies