Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of Villaba )
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WAIVER OF LIABILITY

We, the undersigned members of the faculty, staff and job order of the Visayas State
University Villaba Campus, after having duly sworn to in accordance with law, do hereby
depose and state that:

1. We are current members of the faculty, staff and job order of the Visayas State
University Villaba Campus;

2. On June 22-23, 2017, we will be having a Team Building at Maasin, Matalom

and Inopacan, all in the Province of Leyte;

3. By this Waiver, we assume any risk, and take full responsibility and waive any
claims of personal injury to ourselves, death or damage to personal property,
associated with our attending the Team Building;

4. That we hold the Visayas State University and/or any of its constituents free and
harmless from any and all liability or cause of action arising from any risk, injury,
damage or death that might result to our unanimous decision to attend the Team
Building;

5. In signing this waiver, we acknowledge and represent that WE HAVE READ THE
FOREGOING Waiver of Liability, UNDERSTAND IT AND SIGN IT VOLUNTARILY
as our own free act and deed; no oral representations, statements or
inducements, apart from the foregoing written agreement have been made; and
WE EXECUTE THIS WAIVER FOR FULL, ADEQUATE AND COMPLETE
CONSIDERATION FULLY INTENDING TO BE BOUND BY THE SAME.

IN WITNESS WHEREOF, I have hereunto set my hands this 31st day of May, 2017 at
Villaba, Leyte, Philippines.

NAMES IDENTIFICATION CARD NOS./ SIGNATURE

1. MARIA JEHAN P. LIBRE _____________________________________

2. JESSICA A. DUALLO
3. JOLLY CONVERSION MARQUEZ
4. ELLAINE TUMAMAK
5. MARLON PELOSTRATOS
6. JECIL YUZON
7. DAPHNE LAINE D. AYO
8. MANILYN ONDOS
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
 9. JUMMAR CASAS _____________________________________
10. ROSETTE A. ILAGAN _____________________________________
11. RHODELYN DONCILLO _____________________________________
12. ORLANDO PELAYO _____________________________________
13. GERRY CUEVA _____________________________________
14. LIEZEL ELIVERA _____________________________________
15. LOMERIO HILLARIO _____________________________________

SUBSCRIBED AND SWORN to before me, this _____________________ at Villaba,

Leyte, by the Affiants who are personally known to me (or whom I have identified through
competent evidence of identity as indicated above).

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2017.