Republic of The Philippines) - City) S.S

You might also like

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 2

REPUBLIC OF THE PHILIPPINES }

_______ City } S.S.

ASSUMPTION OF RISK, WAIVER, AND RELEASE FROM LIABILITY

KNOW ALL MEN BY THESE PRESENTS:

            That I, _______________________________________, Filipino citizen, of legal


age,________ a resident of _________________________________________________
and presently employed with ASIAN TECHNOLOGY SERVICES, INC. (the
“Company”), do by these presents understand and acknowledge that I volunteered
and requested the Company to allow me to work to the Company’s office premises
despite the Covid-19 pandemic outbreak. I recently gave birth to my child on
___________________. However, I no longer lactate to feed my newly born child as
evidenced by the attached Medical Certificate issued by _______________________
dated ________________________.

I fully understand and acknowledge that my continued rendering of work at


the office premises of the Company, including my travel to and from the office
premises, may expose me to risks such as Covid-19 infection which may result to
illness or death. I recognize that the nature of my work does not allow me to render
my tasks, duties and assignments from home and that instead of being placed under
a “no-work-no-pay” scheme, I have requested the Company to allow me to work at
the office despite my knowledge of all the risks involved. In view thereof, I
voluntarily assume all the risks that may arise out of or result from working at the
office premises, including those risks as described above.

            In consideration of my willingness to accept and assume the risks involved in


continuing to render work at the office premises of the Company, I do hereby
unconditionally release the Company, its directors, officers, employees, agents and
clients from all liability relating to my continued working at the office premises of
the Company during the Covid-19 pandemic outbreak.

Further, I do hereby release, waiver, discharge, and covenant that I will not
file any actions, claims, disputes, grievances or complaints of whatever nature,
expected, real or apparent, which I may have against the Company, its directors,
officers, employees, agents and clients by reason of or arising from my continued
rendering of work at the office premises of the Company. I will institute no action,
whether civil, criminal, labor or administrative against the Company, its directors,
officers, employees, agents and clients. 

            I declare that I have read this document and have fully understood its
contents.  I further declare that I voluntarily and willingly executed this Assumption
of Risk, Waiver and Release from Liability with full knowledge of my rights under the
law.

            IN WITNESS WHEREOF, I have hereunto set my hand at _______________,


this _______________ 2021.

1
____________________________
Signature Over Printed Name

SUBSCRIBED AND SWORN to before me this _______________ 2021 in


_____________ City, affiant exhibiting to me his identification card, as follows:

Identification Card No. Issued at Expiring on

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2021.

You might also like