Unit 711 2301 Civic Place Building

Civic Drive, Filinvest Corporate City

Alabang, Muntinlupa City
Tel No. (02)808-3469 Tel/Fax No. (02)823-4184
Email: machineryreliability@fastmail.fm

WAVER FORM
Name of Activity: Engine performance test Onboard MV General
Natividad
Data of Activity:
September 3, 2015
WE HEREBY ASSUME ALL OF THE RISKS OF PARTICIP ATING IN THIS ACTIVITY,
including by way of example and not limitation, any risks that may arise from negligence or
carelessness on the part of the persons or entities being released, from dangerous or defective
equipment or property owned, maintained, or controlled by them, or because of their possible
liability without fault,
We certify that we are physically fit, have sufficiently prepared or trained for participation i n the
activity, and have not been advised t o not participate by a qualified medical professional. We
certify that there are no health related reasons or problems which preclude our participation in this
activity.
In consideration of our participation i n t h i s activity we hereby take action for ourselves, our
executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) WE WATVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited
to, liability arising from the negligence or fault of the entities or persons released, for our death,
disability, personal injury, property damage, property theft, or actions of any kind which may hereafter
occur to us including our traveling to and from this activity, THE FOLLOWING ENTTTIES OR
PERSONS: LORENZO SHIPPING CORPORATION (LSC) and/or their directors, officers, employees,
crew and contractors;
(B)WE INOEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entitles or persons
mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this
activity, whether caused by the negligence of release or otherwise.
We acknowledged that the LSC and their directors, officers, employees, crew and contractors are NOT
responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific
activity on behalf of the LSC.
We acknowledged that this activity 'may involve a test of persons physical and mental limits and may
carry with it the potential for death, serious injury, and property loss. The risk may include, but are not
limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment,
vehicular traffic, actions of other people including, but not limited to, directors, officers, employees, crew
and contractors, and lack of hydration.
We hereby consent to receive medical treatment which may be deemed advisable in the event of injury,
accident, and/or during this activity.
WE CERTIFY THAT WE HAVE READ THIS DOCUMENT, AND WE FULLY UNDERSTAND ITS
CONTENT. WE ARE AWARE THAT THIS IS A RELEASE OF LIABILITY AND WE SIGN IT Of
OUR OWN FREE WILL.
Participants

Age

Signature

date

1. Nicasio R. Tamayao Jr.

30

___________________

Sept. 3, 2015

2. Mark Glenn Manzano

28

___________________

Sept. 3, 2015