AFFIDAVIT OF WAIVER OF LIABILITY

I, ____________________________________________________, a bona fide student of

_________________________________________, hereby agree on the following terms and
conditions relative to my application for the participation in the On-the-Job Training (OJT)
Program of Land Bank of the Philippines (LBP):

1. That I shall abide by LBP’s rules and regulations in the implementation of it’s OJT
Program;
2. That I shall exert care and diligence in the performance of any task that may be assigned
to me;
3. That I shall waive any claims against LBP for any injury or untoward incident that may
happen to me un the performance of my duties, as a result of my intentional or negligent
act while in the course of my training as Student Trainee;
4. That I shall be held responsible for any damages to property or injury to third person as a
result of my intentional or negligent act while in the course of my training.

Signed on this _______ day of _____________________________, at

______________________, Philippines.

____________________________
Signature of Student

With our consent and approval:

________________________________ __________________________________
Parent’s/Guardian’s Signature over School Representative’s Signature over
Printed Name Printed Name

SUBSCRIBED AND SORN TO BEFORE ME this _______ day of ________________,

20___, at _______________________________________, Philippines.

Doc. No.___
Page No.___
Book No.___
Series of ____