POLYGRAPH EXAMINATION

WAIVER AND RELEASE OF LIABILITY

ID Presented: Driver’s License
ID No.: A02-3-0003243

I Roxanne B. Gardo, voluntarily and consciously agree to be interviewed and to undergo polygraph
examination by examiners of Polygraph Division/Section PNP Crime Laboratory. I understand that I am
entitled to the following rights in the conduct of polygraph examination:

1. I may refuse to be interviewed or examined and, if so, I hereby authorize the Examiner/
Technician PNP Crime Laboratory to inform PMAJ Emon M. De Guzman of my refusal.

2. I may consult a lawyer, my parent(s), relatives or guardians prior to the interview and polygraph
examination.

3. The interview / and or polygraph examination will be terminated at any time I upon my request
and, if so, I hereby authorize Polygraph Division/ Section PNP Crime Laboratory to inform the
requester of my request.

4. All questions to be asked in the polygraph examination will be discussed with me prior to the
actual testing.

5. No questions pertaining to sexual conduct, obscene or offensive to chastity, or morals or decency

will be asked during the interview and/ or the polygraph examination, unless relevant or
necessary in the investigation.

6. I will not be asked any questions pertaining to my religion or political beliefs unless relevant or
necessary in the investigation.

7. I have a right to receive a copy of this “Waiver and Release of Liability” upon request.

I hereby authorize the polygraph examiners of Polygraph Division/Section PNP Crime Laboratory to
disclose to the polygraph requester any information, conclusions, and opinions arising out of or
connected with my interview and polygraph examination, even though such information, conclusions,
and opinions may be unfavorable or may result with adverse consequences to me.

I hereby release and discharge the examiners/ technician or personnel of Polygraph Division/Section PNP
Crime Laboratory and the requester including the investigator-oncase, personnel, representatives,
officers, and managers, from all liability and from each and every demand, claim, or cause of action
existing, or which may hereafter arise, resulting directly/ indirectly from the conduct of my interview
and/ or polygraph examination and/ or publication, communication or dissemination of any information,
conclusion, and opinions arising out of or connected with my interview and/ or polygraph examination.

Highest level of education completed: _______Tertiary Level_____

Given sufficient time to deliberate by signing below, I have carefully read, acknowledge, and fully
understand that I have personally reviewed and completed this “Waiver of Release and Liability”.
My agreement to undergo interview and polygraph examination is given without threats, promises of
leniency or immunity, reward or favoritism, duress, pressure or force, and clemency. I believe that
cooperation with Polygraph Division/Section PNP Crime Laboratory is the best of my own interest.

ROXANNE B. GARDO 11:30 AM March 14, 2024

Print Name and Signature Time and Date Signed
Signature of Examiner/ Technician ______________________________

Form No.: 60319

Revision No.: 50318