HPG(DA) 231107-13309

APPLICANTS
Executive Motorcycle Riding Course (EMCRC)

CHECKLIST OF REQUIREMENTS:

a. Letter of Intent to undergo EMCRC addressed

to D, HPG:
b. Application Form with 2x2 Pictures for
Members of the National Government
Agencies, Local Government Units and
selected civilian;
c. NBI/PNP National Clearance (for Civilian)
d. Notarized Affidavit of Undertaking;
e. Notarized Waiver;
f. Medical Certificate – It Should be indicated that
(You are fit to undergo Motorcycle Schooling);
g. Photocopy Driver’s license (back to back);
h. Covid-19 Vaccine Card; and
i. PNP Pais PDS (for PNP) and Resume (for
Civilian).
 Republic of the Philippines
National Police Commission
PHILIPPINES NATIONAL POLICE
HEADQUARTERS HIGHWAY PATROL GROUP
Camp BGen Rafael T Crame, Quezon City

EMCRC APPLICATION FORM

(For Civilians and Other Local Government Units)

2x2
picture

Date Accomplished: ___________________

Course: Executive Motorcycle Riding Course

PRINT ALL ENTRIES

1. Last Name First Name Middle Qualifier

2. Occupation

3. Position
4. Office Address

5. Home Address

6. Place Of Birth 7. Date Of Birth 8. Age

9. Sex 10.Civil Status 11. Religion

12. Office Telephone No. 13. Cellphone No. 14. E-mail Address

____________________________________ ______________________________________
Endorsed to EMCRC by:
(Man by a PNP Police Commissioned Officer) Signature over Printed Name of Applicant
 APPROVED / DISAPPROVED

_________________________________

Republic of the Philippines )

Quezon City ) S.S.

WAIVER

I, one of the
students/participants has agreed to voluntarily undergo the Executive Motorcycle
Riding Course (EMCRC) to be conducted by the PNP-Highway Patrol Group
covering the period from _____2023 to
2023.

That I was appraised/oriented on the dangers of the course and the risks that
it may impose upon me and I am still willing to undergo the said course despite the
said risks.
That I will not hold LIABLE any of the training committee and staff of the
PNP-Highway Patrol Group (HPG) who will be responsible in the conduct of EMCRC
should something happen to me while undergoing the said course.

Executed this ______day of 2023 at

__

____
(Signature over Printed Name)
SUBSCRIBED AND SWORN to before me on the date and at the place first above-
written.

Doc. No.
Page No.
Book No.
Series of 2023.

Republic of the Philippines )

Quezon City ) S.S.

AFFIDAVIT OF UNDERTAKING

I, Filipino, of legal age

having been subscribed to an oath, depose and say.

That I am one of the students/participants of the Executive Motorcycle

Riding Course (EMCRC) to be conducted by the PNP Highway Patrol Group for the
month of _________________ 2023.

I was duly informed of the rules and regulations of the Course and I fully
understood and agreed to obey, abide, respect and to undertake the following:

a. That I agreed voluntarily undergo the EMCRC course.

b. That understand that the course has a limited fund allocation from the PNP
thus, I am willing to shoulder the expenses for my schooling if accepted.
c. That, I fully understand the dangers of undergoing the EMCRC and I am
very much willing to assume the risk and relieve the Group and/or the
training instructors and staff of any liability for any act or omissions arising
or connected with the training.
d. That I affirm and understand the contents of this affidavit and executed the
same out of voluntary free will without force, intimidation or violence upon
myself.
 ____
Affiant

SUBSCRIBED AND SWORN to before me on the date and at the place first above-
written.

Doc. No.
Page No.
Book No.
Series of 2023