BML Form 2-C                                  U,P. MARINE SCIENCE INSTITUTE                                        Indemni...
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  1. 1. BML Form 2-C U,P. MARINE SCIENCE INSTITUTE IndemniW and Wa.lver FormI,of---in *^tdrratXn of ine U.P. Marine Science Institute (hereinafter refewed to as "the Itutitute" whichexpression shall when the context admits or requires be deemed to include its fficers and agents)HEREBY AGREE as follow.r : 1. I HiiREBy KELEASE AND FOREVER DISCHARGE the Institutefrom all actions, proceedings, suits, costs, claims and demands which I might have or but for the signing of this -agreement might have had against the Institute Jbr any loss, damage or iniury 6ncluding diath) of u,haisoever nature and howsoever, arising in connection with or arising out a/my voluntary engagement with or workingfor the Institute whether caused by any act or omission of the Institute or the negligence, default or miscanduct of the Institute or otherwise . howsoever. 2. I HEREBY INDEMNIFY AND AGREE TO KEEP INDEMNIFIED thc InStiTUICfTOM ANQ agairct all actions, proceedings, suits, costs, claim"v and demands and the cost reasonably incurred in defending or resi,sting the sarne whiclt m.ay hereafter he made by any per,son or persons in respect of any strch loss, damage or injury Qncluding death) as qfqresaidDATED this _day oJ-*-, 20-. SignctureNAITURE OF ACTIVITY:PARTICULARS IN CASE OF EMERGENCY:Full name:Address & Phone No.:Next of kin:Relationship of next of kin:Address & Phone No. of next of Hn:I 6 Jun 2003

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