RELEASE AND WAIVER

(REQUEST FOR TEMPORARY POWER INTERRUPTION

RTPI/ RESTORATION)
Our company, _______________________________ with principal office
at __________________________________________________ represented by
____________________________do hereby waive any and all rights of action,
claims or demands for any loss of life, physical injury or damage to property that
may be suffered by our company, employees or agents, arising from the action
taken by the Manila Electric Company (MERALCO) upon our request for
temporary power interruption or arising from the restoration of power.
Furthermore, our company agrees to hold MERALCO, its offices,
employees or agents free and harmless from any cause of action or claims for
damages of third parties arising from, or incidental to the power interruption
and/or restoration of power to the aforesaid property or premises of our company
on ______________, 200__.
Moreover, in the event that MERALCOs personnel and/or its contractors
are injured or its equipment damaged as a result of the temporary power
interruption and/or restoration of power, all costs and expenses attendant thereto
shall be borne by our company.
PROVIDED HOWEVER, that this waiver executed by our company in
favor of MERALCO cannot be availed of by the latter by way of special defense
in any judicial proceedings that may arise in connection therewith when such
damage or injury caused to our personnel and property including third parties
was the direct result of MERALCOs fault or gross negligence.
Signed at ______________________ this ______ day of _______, 200__.

______________________________
Name of Corporation, Partnership, or
Single Proprietorship
By:___________________________
Full Name and Position Title
Service ID No.________________
Account Name:________________
Date & Time of Interruption: __________________
Date & Time of Restoration: __________________
Contact Person at site: ______________________
Contact Numbers: __________________________
Reason for interruption: ______________________