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CITY OF DAVAO……………...….) S.S.



I, ___________, of legal age, Filipino, married and a resident of Dumoy,

Talomo District, Davao City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say: THAT-

I am the same ___________ who has been an employee of ____________

from 1978 to 2015, and has retired therefrom upon reaching within the age of
optional retirement;

I affirm that during the period of my employment with ________, I have

been paid of all the benefits, wages, and other compensations due me under any
existing laws including that of the labor code from the date of my employment to
the date of my retirement. I have no claim or claims, money or otherwise, arising
from my employment with __________, and/or to any of its owners;

In consideration of all sums, moneys, benefits and advances I received, I

hereby now and forever release, abandon, and quitclaim any or all claims which I,
my heirs, successors, and assigns may in any event have against _________ Plant,
any of its owners, assigns, affiliates, or their behalf. Furthermore, I will protect
and indemnify ___________, its owners, assigns or affiliates against any and all
claims as may be filed by me or any other person, as a result of or by reason of my
retirement or any matter connected with my employment thereat;

Furthermore, I hereby obliged and bind myself, not to reveal or offer to

reveal any confidential information which I learned or may have come to my
knowledge during my tenure as employee of _____________;

I am executing this affidavit of waiver/quitclaim to attest to the truth of all

the foregoing facts and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of

December 2016 at Davao City, Philippines.

Signed in the presence of:
_________________________ _________________________

SUBSCRIBED AND SWORN to before me on the date and place above-

written. Affiant exhibited to me his SSS ID No._________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2016.