ASKI Skills and Knowledge Institute, Inc.
Talavera Agricultural and Social Enterprise Training Center (TASEC)
Brgy. Sampaloc, Talavera 3114, Nueva Ecija, Philippines
HEALTH DECLARATION FORM
I hereby certify that the information given is true, correct, and complete. I understand that
failure to answer any question or any falsified responses may have serious consequences. I
understand that my personal information is protected by RA 10171 or the Data Privacy Act
of 2012 and that this form will be destroyed after 2- days from the date of accomplishment,
following the National Archives of the Philippines protocol.
____________________________________________
Signature
ASKI Skills and Knowledge Institute, Inc.
Talavera Agricultural and Social Enterprise Training Center (TASEC)
Brgy. Sampaloc, Talavera 3114, Nueva Ecija, Philippines
HEALTH DECLARATION FORM
I hereby certify that the information given is true, correct, and complete. I understand that
failure to answer any question or any falsified responses may have serious consequences. I
understand that my personal information is protected by RA 10171 or the Data Privacy Act
of 2012 and that this form will be destroyed after 2- days from the date of accomplishment,
following the National Archives of the Philippines protocol.
____________________________________________
Signature
ASKI Skills and Knowledge Institute, Inc.
Talavera Agricultural and Social Enterprise Training Center (TASEC)
Brgy. Sampaloc, Talavera 3114, Nueva Ecija, Philippines
HEALTH DECLARATION FORM
I hereby certify that the information given is true, correct, and complete. I understand that
failure to answer any question or any falsified responses may have serious consequences. I
understand that my personal information is protected by RA 10171 or the Data Privacy Act
of 2012 and that this form will be destroyed after 2- days from the date of accomplishment,
following the National Archives of the Philippines protocol.
____________________________________________
Signature
ASKI Skills and Knowledge Institute, Inc.
Talavera Agricultural and Social Enterprise Training Center (TASEC)
Brgy. Sampaloc, Talavera 3114, Nueva Ecija, Philippines
HEALTH DECLARATION FORM
I hereby certify that the information given is true, correct, and complete. I understand that
failure to answer any question or any falsified responses may have serious consequences. I
understand that my personal information is protected by RA 10171 or the Data Privacy Act
of 2012 and that this form will be destroyed after 2- days from the date of accomplishment,
following the National Archives of the Philippines protocol.
____________________________________________
Signature