Republic of the Philippines POLYTECHNIC UNIVERSITY OF THE PHILIPPINES OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS COLLEGE OF ENGINEERING DEPARTMENT OF ELECTRICAL ENGINEERING WAIVER KNOW ALL MEN BY THESE PRESENTS: I, Maverick John L. Cabrito , Filipino, 19 years of age, single/married. With residence at Rd. 2 I. Marcelo St., Malanday, Valenzuela City and presently enrolled at the Polytechnic University of the Philippines, College of Engineering and Architecture, Sta. Mesa, Manila, hereby voluntarily renounce and waive, with the consent and conformity of my parents/guardian, all claims that I may have against Polytechnic University of the Philippines, and/or its officials, arising from any cause/s that may occur in connection with my On the Job Training at ALCON Philippines Technologies and Solutions Inc . This waiver is valid only on the duration of the said On-the-Job Training. IN WITNESS WHEREOF, I hereby affix my signature this _______ day of _________, ______ at ______________________________. WITH MY CONSENT AND CONFORMITY: ______________________________________ ____________________________ Parent/Guardian’s signature over printed name Signature of student SUBSCRIBED AND SWORN to before me, this _____ day of __________, ______, by _________ _____________________, who exhibited to me his Residence Certificate No. __________________ Issued at _________________________ on _______________________. Notary Public Until May 31, _______ PTR No. ________________ Doc. No. _____ Page No. _____ Book No. _____ Series of _____ PUP NDC Campus Anonas Street, Sta. Mesa, Manila Phone: (Direct Line): 7166273 website: www.pup.edu.ph e-mail: [email protected] “THE COUNTRY’S 1 st POLYTECHNICU” CTC NO. Issued at on ________________ ________________ ________________