BATAAN PENINSULA STATE UNIVERSITY

Main Campus, Capitol Drive, Balanga City 2100 Bataan

COLLEGE OF INFORMATION AND COMMUNICATIONS TECHNOLOGY
Office of the OJT-Coordinator Tel.No. 237-2010

________________________
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

Major in .

I, a bonafide student of Bataan Peninsula

(Name of Student)

State University – Main Campus, Academic Year _. Hereby affirm that the company
herein stated is no way responsible nor shall pay compensation for any untoward incident that may happen during my
training since I am insured under the Group Accident and Health Program (GAHP) of the University.

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

(Signature of Parent/Guardian over printed Name) (Signature of Trainee over printed Name)

(Date) (Date)

SIGNED IN THE PRESENCE OF:

NOEL N. TOLENTINO
CICT OJT Coordinator

(Date)

SUBSCRIBED AND SWORN TO before me this day of , 20 at BPSU Main

Campus, City of Balanga.

Dr. PERLA B. ESTRELLA, Ph.D.

Director, Student Affairs

VISION: MISSION:
A university of excellence acknowledged in the country and in To provide quality and relevant education that will develop
the Asia-Pacific Region for its quality graduates and highly qualified and competitive human resources responsive
knowledge responsive to socio-economic needs to national and regional development