I.

RA 10931 BENEFICIARY PROFILE SUMMARY

Student’s Full Name Ambulo, Mohammad Naim M.

(Last Name, First Name, Middle Name)

Higher Education Institution Caraga Institute of Technology

4th Year, Bachelor of Science in Business
Year Level, Program/Course
Administration
Home Address P-7 Anahaw, Alegria, Surigao del Norte

Contact Number 09510920313

Email Address mambulo@citkitcharao.edu.ph

UniFAST Program Free Higher Education

Tertiary Education Subsidy
Tulong Dunong Program

Academic Year/s of Coverage from AY 2018-2019 to AY 2021-2022

(Ex. from AY 2018-2019 to AY 2021-2022)

Social Media Account Link, if

available (Facebook, Twitter, https://www.facebook.com/mohammadnaim.ambulo
Instagram, Youtube, etc.)

Comments or Remarks
Married with 9 siblings, 6 of whom are all in college

II. GUIDE QUESTIONs/ TOPICs FOR STORY CONTENT

● Past condition as a student before becoming an FHE or TES beneficiary

● How or when have you heard of the RA 10931 programs?
● Relate experience upon becoming an FHE/TES/TDP beneficiary
● Overall impact of the program/s in your life
● Message of thanks to PRRD, Chairman De Vera and CHED, UniFAST
Secretariat, school officials

*Please provide a high resolution (300ppi/3.5 MB) profile photo of the grantee and supporting photos
with family, friends and/or school-related photos, if available.

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 III. CONSENT, WAIVER AND QUITCLAIM FORM

I, ______________________________________,
Mohammad Naim M. Ambulo of legal age, Filipino, and with residence
at _______________________________________________________
P-7 Anahaw, Alegria, Surigao del Norte hereby states that:
I give my full consent and permission to the Commission on Higher Education-Unified
Student Financial Assistance System for Tertiary Education (CHED-UniFAST) and its agents
and assigns, to use my name, picture, likeness, image, illustration and/or story as a Free
Higher Education beneficiary/Tertiary Education Subsidy grantee for the UniFAST
Milestones Book Project, and its other related activities, and I acknowledge that I will not
receive any compensation for the use of the Content.

1. I acknowledge and agree that all the materials in which the Content will be featured may
be reproduced and published in all formats and media, and otherwise used in connection
with the UniFAST Milestones Book Project.

2. I agree that my name and any other personal information (i.e., address, date of birth,
and contact details) provided by me to CHED-UniFAST may be displayed, accessed,
stored, processed, or disclosed in connection with the UniFAST Milestones Book
Project.

3. I acknowledge that the Content, as featured in the UniFAST Milestones Book Project,
may be edited, and/or combined with other material/s, and I waive any claim based on
legal, privacy, ethical and/or moral rights in connection with the use of the Content.

4. I warrant that I have full ownership of and possession of the copyright and other related
rights over the Content and that there are no actions, suits or proceedings, claims or
disputes pending or threatened or contemplated in writing, before any court or
administrative agency of any jurisdiction, in the Philippines or abroad, with respect to the
Content, and I release CHED-UniFAST, and its agents and assigns, from any and all
actions, suits or proceedings, claims or disputes which may arise out of or are in any
way connected with its use of the Content.

5. I warrant that I am of legal age and competent to execute this Consent, Waiver and
Quitclaim in my own name.

6. I acknowledge that I have read and fully understood the terms and conditions of this
Consent, Waiver and Quitclaim prior to executing it.
Mohammad Naim M. Ambulo
_________________________
Printed Name and Signature
March 21, 2022
_________________________
Date

09510920313
_________________________
Telephone / Mobile Number

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