RELEASE, WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I/we _________________________, of legal age, Filipino and a resident of

______________________________, hereby depose and state that:

1. That I ________________ am the legally spouse of Mr. Tapias who died on

2. In connection with my _______________________, I hereby acknowledge

receipt of the amount of _______________________ (PhP____________),
representing payment of my __________________________;

2. In consideration thereof, I hereby remise, release and forever discharge

and by these presents do, for myself, my heirs, successors, executors, administrators
and assigns, remise, release and forever discharge company name
, its successors and assigns, and/or its directors, trusties, from any and all
manner of action or actions, cause or causes of action, sum or sums of money,
accounts, damages, claims and demands whatsoever, in law or in equity, arising out of
or in connection ______________________________.

3. I have not authorized and will not authorize any party or person to file a
case in my behalf before any court of law, the Department of Labor and Employment,
National Labor Relations Commission, or any government agency/tribunal regarding
any matter or incident arising out of, or in connection with my
_________________________________; and,

4. In this connection, I agree not to disclose/divulge/share/reveal any and all

confidential and/or proprietary information of/relating to company name
.

I hereby declare that I have read and fully understood this document and the
legal consequences thereof before signing the same, and that this release and quitclaim
is made willingly and voluntarily and with full knowledge of my rights under the law.

IN WITNESS WHEREOF, I hereunder sent my hand this _____ day of ________

2012, in ___________ City.

_________________________
(name)

SUBSCRIBED AND SWORN to before me in ________________ this ___ day

of ____________ 2012 by _________________________, who has satisfactorily
proven to me his identity through his _____________________ valid until
____________________, that he is the same person who personally signed before me
the foregoing affidavit and acknowledged that he voluntarily executed the same.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2012.