Republic of the Philippines

SOUTHERN LUZON STATE UNIVERSITY

Lucban, Quezon
LIABILITY WAIVER
I, MIGUEL FRANCO M. MORONG , a student of SOUTHERN LUZON STATE UNIVERSITY
(SLSU) in Lucban, Quezon, hereby voluntarily agree to undergo on-the-job training at
L.A. CLAMOR CONSTRUCTION
This activity as I fully understand is a part of the curriculum I am presently enrolled.
With thorough understanding therefore the requirements of the course and the existing policies
and regulations related to my training, I hereby declare the following:
1. That I shall abide all existing rule and regulations imposed upon by the company. And
that, violation of such will mean disciplinary action by the company or termination of my
training;
2. That I shall be made answerable for any and all liabilities for damage to property or
injury to third persons that may be caused by my intentional or negligent acts while in the
course of my training;
3. That I shall waive any claim for an injury that I may sustain or suffer whether personal or
pecuniary in the performance of my duties and functions while under training;
4. That there shall be no employer-employee relationship between the company and me.
Signed this ___________ day of ______________,______ at Southern Luzon State
University, Lucban,Quezon.
Miguel Franco M. Morong
Signature of student
WITH OUR CONSENT AND APPROVAL:

Celerina Edna M. Morong_

Signature over printed name
Res. Cert. no.__07822732____
Issued on______01/24/2014__
Issued at___Sariaya, Quezon_
__________________________
OJT Coordinator
SUBSCRIBE AND SWORNE TO BEFORE ME THIS_____________ day of _______,
______ at _______________________________, PHILIPPINES.
______________________
Notary Public
Doc. no.
Page no.
Book no.
Series of

____________
____________
____________
____________

AA-INS-3.03F3, Rev.0