AFFIDAVIT

I, _______________________________________________, Filipino, _______ years old, single/married and residing at

________________________________________ after having been duly sworn in accordance with the law, hereby depose
and state that:
1.

2.

3.

4.

5.
6.

In submitting my essay, titled __________________________________________, to participate as an applicant in the

450 Kaplag National Essay Writing Contest (Tertiary Level) being sponsored by 450 Kaplag Executive Committee and
for other good and valuable considerations, I irrevocably give 450 Kaplag Executive Committee and its agents and
contractors the right and permission to use, copy, alter, distribute, publish, broadcast, and display the aforementioned
Essay that I have submitted; my name; the city, state, or province in which I live; and other information and material
included in my Entry Application, on 450 Kaplag Executive Committee website, elsewhere on the Internet, in advertising
and promotional materials, and in any other medium or format for any purpose related to the 450 Kaplag National Essay
Writing Contest (Tertiary Level) .
I acknowledge and agree that if I am selected as a finalist for the 450 Kaplag National Essay Writing Contest (Tertiary
Level), 450 Kaplag Executive Committee may post the Essay on the Internet and allow the public to view the material
for free. I waive any right to royalties or other payment for the use of my Essay and I also waive the right to inspect or
approve 450 Kaplag Executive Committee use of the Essay and other materials that 450 Kaplag Executive Committee
may use with them.
I attest that there is no copyrighted material in my Essay. I release and waive and agree to hold 450 Kaplag Executive
Committee, its agents, and its contractors harmless from any claims, damages, or liabilities resulting from their use of
the Essay and I agree not to bring any such claims against the released parties at any time in the future. This includes,
but is not limited to, claims for violation of publicity rights and privacy rights, claims based on moral rights, claims for
intrusion, claims for defamation, claims for fraud, claims for infliction of emotional distress, and claims for copyright or
other intellectual property infringement, whether those claims may be based on statutes or the common law.
I represent and warrant to 450 Kaplag Executive Committee that: The Essay is my original work. I have not granted
anyone else any rights to use, distribute, publish, broadcast, or display the Essay. I have the full right and authority to
execute this Release and Waiver. I have all rights necessary to grant the rights, waivers, and releases granted in this
Release and Waiver. I have read this Release and Waiver and I fully understand it. All statements and information
included in my Entry Application and any other statements and information that I provided to or will provide to 450
Kaplag Executive Committee are true and complete.
If I fail to claim my ENTRY on the dates specified in the rules, then I agree that it shall automatically become the propert y
of 450 Kaplag Executive Committee.
I have read and I will abide by the rules, regulations and requirements governing the above mentioned competition and,
in this regard, I hereby exempt, discharge, release and free 450 Kaplag Executive Committee and its
directors/trustees/officers and staff and shall defend and hold them free and harmless from any claim, liability or legal
action arising from any potential or actual loss or damage arising from breach or falsity of any of my representations ,
acceptances or undertakings herein and from any claim or liability from any loss or damage which my ENTRY may
suffer while being transported or while otherwise in the custody of the 450 Kaplag Executive Committee.

I am executing this affidavit to attest to the truth, veracity and validity of all the foregoing and to certify, under oath, originality,
authenticity, and ownership of my above mentioned ENTRY, under pain of perjury.
In witness whereof, I have hereunto set my hand this _________ day of ______________________ 2015, in the City/
Province of __________________________, Philippines.

______________________________
AFFIANT

REPUBLIC OF THE PHILIPPINES

(City/Province of _______________________) S.S.

SUBSCRIBED AND SWORN TO before me this _________ day of ______________________ 2015, in

________________________, affiant exhibiting his/her [government-issued ID details] ________________________ __ __
with expiry on _________________________.

Doc. No. ......... :

Page No. .......... ;
Book No. ......... ;
Series of 2015.