BEAR BRAND®

BATANG MATIBAY 2023 AWARDS:

Nomination Form

STUDENT NOMINEE: ________________________________________________________

SCHOOL: ________________________________________________________

NOMINATION CHECKLIST

 Fully accomplished BEAR BRAND® BATANG MATIBAY 2023 Nomination Form

 Fully accomplished BEAR BRAND® BATANG MATIBAY 2023 Consent, Release and Waiver Form

 Photocopy of the student nominee’s report card or transcript of records for the current school
year 2022-2023

 Certificate of Good Moral Character of the student nominee

 Additional documents to support the nomination, such as proof of involvement in extracurricular

activities, leadership roles, or community service.

Place all requirements in a long brown envelope with the student nominee’s name and school name on
the upper left corner.
 BEAR BRAND®
BATANG MATIBAY 2023 AWARDS:
Nomination Form

INSTRUCTIONS: Please fill out the required information and answer the questions completely. You may use extra
sheets of paper if needed. Entries may either be typed or handwritten – for legibility, typed entries are preferred.
For handwritten entries, please make sure to use block letters (NOT cursive).

PANUNTUNAN: Punan ang mga kinakailangang inpormasyon at sagutan nang kumpleto ang mga katanungan.
Maaaring gumamit ng karagdagang papel kung kinakailangan. Maaaring i-type or isulat-kamay ang mga sagot –
para mas madaling basahin, mas maigi na i-type ang mga sagot. Para sa sulat-kamay na entries, gamitan lamang ng
block letters (HINDI cursive).

STUDENT NOMINEE

NAME: ____________________________________________

SEX: _____________________ AGE: ___________________

BIRTHDAY: ________________________________________

GRADE LEVEL: _____________________________________ 2X2 ID PHOTO OF

NOMINEE
HOME ADDRESS: ___________________________________

CONTACT NUMBER: _________________________________

FATHER: __________________________________________

MOTHER: _________________________________________

EXTRA-CURRICULAR INVOLVEMENT (SCHOOL/COMMUNITY)

LIST OF ACADEMIC ACHIEVEMENTS LIST OF EXTRA-CURRICULAR ACTIVITIES IN

SCHOOL (Organization/Clubs, Programs, Sports,
Etc.)

1) ________________________________ 1) ________________________________
2) ________________________________ 2) ________________________________
3) ________________________________ 3) ________________________________
4) ________________________________ 4) ________________________________
5) ________________________________ 5) ________________________________

OTHERS: If applicable, please list down projects that

were initiated by the student within his/her school and/or community that made a positive impact.

Kung maaari, mag-lista ng mga proyektong pinangunahan ng estudyante sa kanyang paaralan o komunidad na may
mabuting epekto sa kapwa.

_______________________________________________________________________________________________
______________________________________________________________________________________________.

NOMINATORS

NAMES OF NOMINATORS: SCHOOL NAME AND ADDRESS:

(Minimum of 3 faculty members)
____________________________________
 FOR THE NOMINATORS

1. Please tell us about your personal account of how this student demonstrated grit/TIBAY to face
different obstacles in his/her life.
Maaaring mag-lahad ng iyong personal na karanasan kung paano naipamalas ng estudyante ang
kaniyang tibay para harapin ang mga hamon sa buhay.
2. What makes the story of this student a unique inspiration to his peers and community?
Paano nata-tanging inspirasyon ang kuwento ng estudyante sa kanyang kapwa at komunidad?

We certify that the above information is true and correct.

____________________________________________
Name and Signature of Faculty Member
Designation:_ _ _ _ _ _ _ _ _ _ _ _ _ _
____________________________________________
Name and Signature of Faculty Member
Designation:_ _ _ _ _ _ _ _ _ _ _ _ _ _

____________________________________________
Name and Signature of Faculty Member
Designation:_ _ _ _ _ _ _ _ _ _ _ _ _ _

FOR THE STUDENT NOMINEE

1. Tell us about your dreams and aspirations. What are the challenges you face which may hinder in
achieving these? How do you overcome these challenges?
Ilahad mo ang iyong mga pangarap at aspirasyon sa buhay. Anu-ano ang mga kinakaharap mo na
maaaring maging hadlang sa pagkamit ng iyong pangarap? Paano mo nalalampasan ang mga
pagsubok na ito?
 I, __________________(Name of Student), certify that the above information is true and correct.

______________________________________ ______________________________________
Name and Signature of Student Name and Signature of Guardian/Parent

BEAR BRAND®
BATANG MATIBAY AWARDS:
CONSENT, RELEASE AND WAIVER FORM

PLEASE READ THIS BEFORE SIGNING: TO BE ACCOMPLISHED BY PARENTS / LEGAL GUARDIAN

OF THE NOMINEE
I, _______________________________________________, Filipino, of legal age, residing at
______________________________________________________, after having been duly sworn to in
accordance with law, hereby depose and state that:

1. I voluntarily, freely, and gratuitously agree to the use of ____________________________

Name of child/ward
image, and likeness for internal and external commercial advertisements and/or marketing
communications campaigns (“BEAR BRAND® BATANG MATIBAY AWARDS”) of Nestle
Philippines Inc. (“NPI”).

2. In consideration of my and/or my child/ward’s enjoyment and receipt of the benefits resulting

from my participation in the Activity, I voluntarily, freely and gratuitously agree to have my
and/or my child/ward’s photograph and/or video taken (hereinafter referred to as "Materials")
and agree to the use of my and/or my child/ward’s personal circumstances including but not
limited to my and/or my child/ward’s name, image, likeness and any matter which my child
may disclose as a participant in the Activity, for the development and use of the Materials by
NPI and/or its principals. For the avoidance of doubt, I understand that no compensation shall
be due to me for any use of the Materials hereunder.

3. NPI and/or its principals can use, exhibit or release the Materials and use any of the
foregoing details in the said Materials for the marketing communications campaign,
advertising materials and packaging of NPI and/or any NPI products, without limitation as to
place, time, use and medium of release, subject to the provisions under paragraph 8 below.

4. NPI and/or its principals shall not be liable for any unauthorized use, reproduction or
adaptations by third parties of the Materials or for any unauthorized posting, use,
reproduction or adaptation of the same in MMS messages, internet sites such as but not
limited to Facebook and other similar media and/or social networking sites. No fee shall be
due me for such unauthorized use.

5. NPI and/or its principals shall have the right to and ownership over the titles and interests in
and to the Materials. Accordingly, all the intellectual property created and derived from such
Materials shall be solely and exclusively owned by NPI and/or its principals, in perpetuity and
without limitation as to place, time, medium and use thereof.

6. I am not bound by any written agreement or contract to any person or entity who may restrain
me from signing this Consent, Release and Waiver.

7. I am giving permission to NPI and/or its principals to contact me using the contact details I
have provided for upcoming promotions and activities of Nestlé Philippines Inc.

8. I understand that personal information about my child/ward shall be supplied to the

Organizer, including his/her name, age/date of birth, contact details, photo, school, school
division, region and personal circumstances, shall be collected by the Organizer and NPI for
purposes of running this Activity. By signing this waiver, I signify my understanding and
consent to the following:

a. I agree and understand that in the course of providing service/s to me or my Child/Ward,

NPI shall engage the services of, and/or interact with, other third parties, such as, but not
limited to its parent company, affiliated companies, or independent/non-affiliated third
parties and service providers, whether local or foreign (collectively referred to as
"Representatives").
 b. NPI may obtain, collect, examine, process, and store copies of my and/or my child/ward’s
personal information, including sensitive personal information. Any information obtained
relative to the authority herein given shall be strictly confidential. The extent of the
collection and processing shall be necessary and incidental to the performance of the
services related to the Activity;

c. NPI may disclose such information to its Representatives to perform the services related
to the Activity, for any legitimate business purpose as NPI may deem appropriate, or to
communicate with me for any purpose;

d. I hereby warrant that we understand our rights and obligations pursuant to the Data
Privacy Act and its implementing rules and regulations. I understand that we retain the
right to be informed, to access, correction and object to the processing of personal
information, as well as the right to complain with the National Privacy Commission.

9. I confirm that my child/ward does not possess the disqualifications for the Batang Matibay
Awards.

10. I fully accept the terms and conditions above including the rules for the Batang Matibay
Awards.

___________________________________
PARENT/LEGAL GUARDIAN
NAME AND SIGNATURE