UNIVERSITY OF THE PHILIPPINESCOLLEGE OF MEDICINE
Pedro Gil St., Ermita, Manila
RETURN SERVICE AGREEMENT (RSA)
This Return Service Agreement made and executed this ______ day of____________________ in ______________________, Philippines by andbetween:,

Filipino, of legal age,(full name of student)
married to _________________, with residence and(full name of spouse)postal address at ____________________________________,(complete address)
hereinafter referred to as “Student”;single/- and University of the Philippines, the national university of the Republicof the Philippines, created and organized under Act No. 1870 andRepublic Act No. 9500, represented by DR. MICHAEL L. TEE,MHPEd, MBA, Chancellor of the University of the Philippines
Manila, representing the U.P. College of Medicine, hereinafterreferred to as “UPCM”;
WITNESSETH: That
WHEREAS, the Return Service Agreement (RSA) or Policy of the UPCM
(hereinafter referred to as the “Policy”) strives to ensure excellence andleadership in community-oriented medical education, research and service; using
the Primary Health Care Approach; intended especially for the underserved;
WHEREAS, the Student is covered by Article I below under theabovementioned Policy and is aware of the requirements of the same; and, forthis purpose, the Handbook on the UPCM Return Service Obligation Program forstudents starting Learning Unit 1 or Learning Unit 3 during the Academic Year2024-2025 is hereto attached as Annex “A”, the same to form an integral part
hereof;
WHEREAS, the RSA becomes effective only upon acceptance of theStudent to the UP Manila College of Medicine;
WHEREAS, in consideration of her/his admission to the UPCM andher/his being covered under the abovementioned Policy and considering her/hisavailment of state subsidy for her/his tuition and other fees, the Student is thus
required by UPCM to render health care services in the Philippines, immediately
after her/his graduation;
NOW, THEREFORE, the foregoing premises considered, the Parties
hereto hereby agree as follows:

Page 1 of 3

Article I. Obligations of the Student
The Student, having been accepted to the UPCM and covered by/under theRSA Policy, shall:
1. Faithfully adhere to the Vision-Mission of the UPCM, specifically the ideals
and requirements of the Program;
2. Abide by the prescribed course of instruction;
3. Obtain a Philippine Medical License within 2 years from the date of her/hisUPCM graduation
4. Render health care services in the Philippines for a minimum of three (3)years within five (5) years from the date of her/his UPCM graduation;
Submit on or before June 30 and December 31 of every year until completion ofthe Return Service Obligation, beginning the year he/she graduated from UPCM,
a report of her/his health care activities and services for the preceding 6 months
providing the necessary details as required by the UPCM.
Article II. Penalty for Breach of Obligation
1. The Student acknowledges and agrees that before the completion ofher/his obligations under Article 1 of this Agreement and such other obligations
as may from time to time be imposed by concerned University Officials in theimplementation of said Agreement, her/his transcripts of grades and/or diploma
shall bear the statement “Subject to compliance with to the Return ServiceAgreement. Valid for employment within the Philippines only”.
2. In addition, the Student shall be held liable for breach of contract jointly
and severally with her/his parents or guardians and guarantor/surety, as provided
for in the Suretyship Agreement hereto attached as Annex “B”, and reimburse toUPCM a payback equivalent to double the cost of medical education up to theyear level completed or currently in.
Article III. Free and Hold Harmless Clause
Any loss and/or damage caused by the Student to any person as a resultof or in connection with her/his performance of health care services as required
under this Return Service Agreement shall be the sole and exclusive liability andresponsibility of the Student. In this connection, the Student holds UPCM freeand harmless from all claims, liabilities, proceedings, damages, costs, charges
and expenses whatsoever arising out of or as a result of such loss and/ordamage.
Article IV. Alternative Dispute Resolution
In case of a dispute between the Parties arising from the breach by theStudent of her/his obligations under this Return Service Agreement, they hereby
agree to freely and voluntarily submit themselves to the necessary consultationand negotiation process for purposes of amicably settling their dispute throughthe Appeals Committee. Should the Parties fail to reach an amicable settlement,
any dispute or controversy arising from this Agreement shall be submitted toarbitration, in accordance with law (RA 9285). Finally, the Parties agree thatshould their dispute reach the courts of law, the competent courts of Manila shallhave exclusive jurisdiction over the same.

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IN WITNESS WHEREOF, the Parties hereto hereby sign this Return
Service Agreement together with the parent(s)/guardian(s) of the Student, this____ day of ________________ at __________________, Philippines.

___________________________Name and Signature of Student

MICHAEL L. TEE, MD, MHPEd, MBA
Chancellor, UP Manila__________________________Name and Signature of Mother__________________________Name and Signature of Father

Signed in the presence of:_______________________________
Signature over printed name of witness

CHARLOTTE M. CHIONG, MD, PhD
Dean, UPCM

Address of the Witness: _____________________________________________________________________________________________________________________ACKNOWLEDGMENT
Republic of the Philippines)__________, Metro Manila) s. s.
BEFORE ME, this ____ day of ____________, in ____________,
personally appeared:
Name

GIID No.

Date/Place Issued____________________________________________________________________________________________________________________________________________________________________________________

known to me and to me known to be the same persons who executed theforegoing instrument and they acknowledged to me that the same is their freeand voluntary act and deed as well as that of the institution represented.
This instrument refers to a Return Service Agreement that consists ofthree (3) pages, including the page whereon the acknowledgment is written.
WITNESS MY HAND AND NOTARIAL SEAL, on the date and place
above-written.
Doc. No ____;
Page No. ____;
Book No. ____;
Series of 202__.
UPCM-RSOP 2023

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SURETYSHIP AGREEMENTfor
UPCM RETURN SERVICE AGREEMENT (RSA)
This Agreement executed at__________on(place)______________ by _________________________ , Filipino, of legal age,(date)(full name of surety)
single/ married to _________________, with residence and postal address(full name of spouse)at ____________________________ , gainfully employed and/or with property,(complete address)
hereinafter referred to as “Surety”, in favor of the University of the Philippines
Manila College of Medicine, with principal office at Pedro Gil St., Ermita, Manila,
hereinafter referred to as “UPCM”;
WHEREAS,(hereinafter referred to as(full name of student)“Principal”), a student of the UPCM, executed the attached Return Service
Agreement with UPCM on ________________________, to which this Surety(date of RSA )Agreement is attached as ANNEX “B”;
WHEREAS, UPCM requires that the due and faithful performance of theprovisions of the said Return Service Agreement be underwritten by a Surety;
NOW, THEREFORE, for and in consideration of the foregoing, theundersigned Surety, jointly and severally with the Principal, hereby guarantee
and warrant to UPCM that the Principal shall comply with and perform all thestipulations contained in the RSA, and that if for any reason the Principal fails tocomply therewith, the Surety binds himself jointly and severally with the Principal:“To reimburse the UPCM twice the full of such amount/s as
may have been defrayed for the Principal’s tuition, government
subsidy and scholarship, and all other expenses incurred by
the UPCM, with interest at the prevailing legal rate at the timeof the breach of the aforesaid RSA”.
The liability of the Surety under this Agreement shall be solidary, direct
and immediate and not contingent upon the enforcement by UPCM of whatever
remedies it may have against the Principal, and the Surety shall at anytime on
demand, pay to the UPCM whatever amount is owing from the Principal to theUPCM to the extent stated above.
This instrument is intended to be a complete and free indemnity to UPCM
for any indebtedness or liability of the Principal arising from the RSA. It shall bevalid and binding without further notice to the Surety, until the Principal has
complied with all her/his obligations under the said RSA.

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IN WITNESS WHEREOF, the Surety has caused its authorized
representative to set her/his hand this ___ day of _________, 201__, in___________________.
_________________________Name & Signature of SURETY___________________________Name & Signature of SPOUSE
of SURETY (if married)

Signed in the presence of:_______________________________ ________________________________
Signature over printed name of witness Signature over printed name of witness
ADDRESS OF THE WITNESSES:
1._______________________________________________________________
2._______________________________________________________________ACKNOWLEDGMENT
Republic of the Philippines)__________, Metro Manila) s.s
BEFORE ME, this ____ day of ____________, in ____________,
personally appeared:
Name

GIID No.

Date/Place Issued______________________________________________________________________________________________________

known to me and to me known to be the same persons who executed theforegoing instrument and they acknowledged to me that the same is their freeand voluntary act and deed as well as that of the corporation herein represented.
This instrument refers to as Suretyship Agreement for UPCM Return
Service Agreement Policy that consists of two (2) pages, including the page
whereon the acknowledgment is written.
above.

WITNESS MY HAND SEAL on the date and at the place first written

Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 202__.
UPCM-RSOP 2023

2REPLY SLIPPlease submit together with your Application Form and other admissions requirements.
Incomplete Application forms will not be accepted.
--------------------------------------------------------------------------------------------------------------------------REPLY SLIP

I certify that I have read and understood the policies and the Implementing Rules andRegulations (IRR) governing the Return Service Agreement (RSA) and for this purpose, hereby
manifest my acceptance and/or faithful adherence thereto.

Signature over printed name:_________________________
Applicant_________________________
Parent / Guardian (s)Date: _______________

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