Republic of the Philippines) City of __________________ of __________________ ) S.S.
UNDERTAKING AND WAIVER I,
__________________________________ , _______ years of age, __________________________________ , age , Filipino, Filipino, with residence and postal address at _____________________________________________ , _____________________________________________ , after having been duly sworn to accordance with law, law, hereby depose and say: 1. That I am an applicant app licant for an on-the-job training (OJT) (OJT) with ___________ for a total of _______ hours in compliance with curriculum requirement in course of ______________________________ which I am taking up at Adamson University, Manila. 2. That I undertake to abide with the company rules and regulations, regulations , policies and procedures of _____________ , while undergoing the OJT; OJ T; 3. That I hereby release _______________ free from any responsibility whatsoever , and waive any claim arising from any injury or accident which I may sustain in the course of my OJT OJT at _________________________ ; _________________________ ; 4. That the on-the-job-training is solely for the purpose of compliance with the curriculum requirement in my course and is not meant to establish an employeremployer- employee empl oyee relationship between me and _________________ , Inc. 5. It is understood that this OJT OJT is with compensation pursuant to and authorized under the Labor Code of the Philippines. IN WIT WITNESS WHEREOF, WHEREOF, I have hereunto affixed my signature this ___ day of ___ , ___ , in the year of Our Lord two thousand and eleven in ______________________. __________________________ Affiant
With our parental consent:
__________________________ Signature of Father
_______________ Signature of Mother
ACKNOWLEDGEMENT BEFORE ME, ME, a Notary Public for and in Manila, Manila , personally appeared the following persons with their Community Tax Certificates numbers and the corresponding corresponding dates and pl aces of issuance opposite their respective names: Name
__________________ __________ ________
Comm. Tax Cert. No.
Date and Place of Issue
_____________________ ____________ _________
_________________________ _____________ ____________
_____________________ ____________ _________
_________________________ _____________ ____________
_____________________ ____________ _________
_________________________ _____________ ____________
applicant
__________________ __________ ________ father
__________________ __________ ________ mother
All known to me and known to be the same person who executed the foregoing Undertaking and Waiver , and they acknowledge before me that the same is their own free and voluntary v oluntary act and deed. WITNESS MY HAND AND SEAL, on the date and place first above abov e written.
NOT NOTARY PUBLIC Not. Reg. No. ________________ ; ________________ ; Page ____ Book ______________: Series of 2011
