REPUBLIC OF THE PHILIPPINES ) CITY OF __________________ ) S.S.

RELEASE, WAIVER AND QUITCLAIM, WITH UNDERTAKING I, ____________________, ____ years of age, Filipino, single/married, with residence and postal address at ____________________________, after having duly sworn to in accordance with the law, depose and state: That -1. I have a claim for payment of deposit in the total amount of __________________ against the assets of !nitrust "evelopment #an$ %!"#&, a closed 'an$ under li(uidation 'y the hilippine "eposit Insurance )orporation % "I)&* +. In line with the ,rder dated -arch 1., +//0 'y the 1egional Trial )ourt of -a$ati )ity, #ranch 2. %the 3i(uidation )ourt of !"#& issued in 4 . 1,). 5o. --6/6. entitled 7In re: etition for 8ssistance in the 3i(uidation of the !nitrust "evelopment #an$,9 authori:ing/approving the payment of my deposit claim, I here'y ac$nowledge receipt from !"#, thru its 3i(uidator "I), the partial payments of my deposit claim in chec$ as follows: ____________ representing 44.4 7 2 ! of my outstanding claim paid to me on __________________ and ______________ representing "2! of my remaining claim of . 7 2 ! , or the total paid amount of ______________ out of my total outstanding deposit claim of _____________________* ;. To my complete and full satisfaction, I here'y RELEASE AND DISCHARGE !"# , to the e<tent of the amount of P _________________. 3i$ewise, I here'y release "I), its officers, employees, agents or representatives, from any and all lia'ilities whatsoever emanating, directly or indirectly, from the claim as partially paid* 8nd for this purpose, I here'y hold "I) and its officers, employees, agents or representatives, legally free and harmless from any and all lia'ilities or claims arising thereto* =. 4hould !"#, or "I) and/ or the latter>s officers, employees, agents or representatives 'e held lia'le/accounta'le for whatever reason as a result of such payment, I here'y agree and underta$e to fully assume the same, and shall indemnify, to the e<tent of the amount of _______________, !"#, or "I) and/or the latter>s officers, employees, agents or representatives either 'y refunding the same upon demand, or indemnifying !"# or "I) for whatever losses or damages that may arise 'y reason of the foregoing payment to the e<tent of the amount partially paid to me 'y !"#, thru its 3i(uidator "I)* 2. Finally, I here'y declare that I have fully read and understood the contents of this document and that this 1elease, ?aiver and @uitclaim, with !nderta$ing is made freely and voluntarily, with full $nowledge of my rights under the law.

IN WITNESS WHEREOF , I have hereunto set my hand this ___ day of ______ +/1; in ________________, hilippines. _____________________ )laimant SUBSCRIBED AND SWORN TO 'efore me this ___ day of ____________, +/1;. The )laimant e<hi'ited to me his/her Identification )ard 5o. _________ issued on ____________ at ______________. 5otary "oc. 5o. ___: age 5o. ___: #oo$ 5o. ___: 4eries of +/1;. u'lic