Agilit Form BFP

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Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION REGIONAL OFFICE III
Del Pilar, City of San Fernando, Pampanga
Telefax No. (045) 963-4378 & (0943) 700-3136
Email: bfpr3@yahoo.cm.ph

AGILITY TEST WAIVER CERTIFICATE

I, _ , years old, resident of


_ do hereby submit
myself voluntarily to undergo the Physical Agility Test (PAT), fully understand that the BFP-
Region 3 shall not be held liable/ responsible for any injury that I may acquire in the process.

Witness Applicant’s Signature

BFP-QSF-HRMD-012 Rev. ØØ (04.04.18)

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