UNIVERSITY OF THE EAST

Manila Caloocan

WAIVER
I, ________________________________ age ___________ and residing
at ____________________________________ and an applicant for the On-the-Job
Training with a cooperating industry through the request of the University of the East
and in consideration thereof, do hereby freely and accept the following duties:
1. That I recognize the authority of my cooperating company or agency where I will
be placed and submit myself to all the reasonable rules and regulations that are
imposed upon me in connection with my training, and
2. That I renounce and waive any claim against the cooperating company/agency
and the University of the East for any injury that I may sustain, or loss that I may
suffer, personal or pecuniary, in the performance of my duties or function while
under training.
Signed in the _______________, Philippines, this _______ day of _____________
20____.
_________________________
Signature of Student
Student No. ____________

WITNESS:
With this consent and approval of Parents/Guardian:
________________________
Signature of Parent/Guardian

SSS/TIN/Voters ID No. ____________

Address: __________________________________________________________
__________________________________________________________________
ATTESTED:
____________________________
OJT Coordinator

__________________________
College Dean

**Please proceed to any Notary Public after securing the signature of the OJT Coordinator and the Dean for
notarization. Kindly bring photocopy of your school ID as a proof of Identity. **

SUBSCRIBED AND SWORN to before me this _______ day of __________ 20___ at Manila,
Philippines. Affiant having exhibited to me his/her Student ID with student number
___________________________.
Doc. No.
Page No.
Book No.
Series of 20__.