REPUBLIC OF THE PHILIPPINES)

Province of Pampanga) S.S.

City of Angeles)
x-----------------------x

WAIVER, RELEASE AND QUITCLAIM

I, _____________________________, Filipino, of legal age, ______ (status) , and a

resident of ___________________________________________________________________,
Philippines, after being sworn to in accordance with law, depose and state:

1. That by these presents, I hereby state that I voluntarily left Bale Theresa prior to the
expiration of my lease contract;

2. That I hereby acknowledge to have paid the lessor the sum of

__________________________ (P_____________) which are advance in rentals
deposit and security deposit for my electric and water bills;
3. That the pre-termination of such lease contract will result to the forfeiture of the above
stated amount.

3. That I hereby declare that I have no further claims whatsoever against the lessor, its
assigns, heirs, officers or any of its staff and that I hereby release and forever discharge
all of them from any and all claims, demands, cause of action of whatever nature arising
out of the pre-termination of the lease contract;

4. I further agree that this QUITCLAIM may be pleaded in bar to any suit or proceeding
to which either I, or my heirs and assigns, may have against my lessor in connection
with the contract of lease with the latter and that the payment or refund which I may
have received as provided herein should not in any way be construed as an admission
of liability on the part of my lessor and is voluntarily accepted by me and will, if need
be, serve as full and final settlement of any amount(s) due me or any claims or cause
of action, either past, present, future, which I may have in connection with the contract
of lease with the lessor;

5. As such, I finally make manifest that I have no further claim(s) or cause of action
against the lessor nor against any person(s) connected with the administration and
operation of the latter and forever release the latter from any and all liability.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

AFFIANT
 SUBSCRIBED AND SWORN to before me, this _____________, by the Affiant whom I
have identified through competent evidence of identity and who exhibited his/her ___________ID
No. _____________ issued at _____________ on _____________.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.