PAMANTASAN NG LUNGSOD NG MARIKINA Brazil St.

Greenheights Subd. Concepcion Uno, Marikina City/1800

PLMar Reg. Tel. No. 369-8650/975-8974/623-5728 /CHTM Tel. No. 966-2583

REPUBLIC OF THE PHILIPPINES

CITY OF MARIKINA
UNDERTAKING AND WAIVER

I,______________________________________, Filipino,____ years of age, with residence and

postal address at ________________________________________, with the assistance of my
father/mother/guardian and after having been duly sworn to in accordance with law, hereby depose
and say that:

1. I am a _________ year student, taking the course

________________________________________ at the Pamantasan Lungsod ng
Marikina;

2. On-The-Job Training ( OJT ) is part of the curriculum prescribed for my course at the
Pamantasan Lungsod ng Marikina;
3. I have volunteered to undergo On-The-Job Training (Work from Home)
at _______________________________ (Name of Company).
4. I undertake to comply with and observe all the rules and regulations of
______________________________(name of the company) during my stay in their
establishment as a trainee;
5. I hereby waive the liability on the part of
_____________________________________________________ (Name of Company) for
any untoward incident that may occur during my stay as a trainee in their establishment
except those brought about by the wilful act or omission of its personnel and/or agents;
6. I also hereby waive liability on the part of the Pamantasan ng Lungsod ng Marikina; for any
untoward incident that may happen during my training since it is my own choice, with the
consent of my parents, to undergo such on-the-job training in partial fulfillment of my
course.
7. I am executing this undertaking and waiver of right to attest to the truth of the foregoing,
and for the purpose of completely adhering to the terms stated above.
IN WITNESS THEREOF, I have hereunto set my hand on this ___ day of _____________, year _________,

in the City of ______________________________________, Philippines.

_________________________
Student/Affiant

This is to confirm that my son/daughter ___________________________________will undergo

_________ (Number of Hours) On-The-Job Training from _______________ (Starting Date)to _____________
(Completion Date)at _________________________________________________________________ (Name of
Company and Address).

CONFORME:

_________________________
Signature over Printed Name of
Father/Mother/Guardian

SUBSCRIBED AND SWORN to before me on the same time and place above written with the
affiant and parent/guardian exhibiting to me the following identification cards:

NAME ID CARD DATE AND PLACE OF ISSUE

______________________ ______________ ___________________________

______________________ ______________ ___________________________

NOTARY PUBLIC

Doc. No. ________;

Page No. ________;

Book No. ________;

Series of 2018.