WAIVER/QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, __(name)__ , of legal age, Filipino, married and a resident of

_(address)__, do hereby ACKNOWLEDGE THE RECEIPT of the
amount of ______________________________________ (Php
_________.00), from __(giver)__, as full settlement of any and/or all
liabilities under the law or under any existing agreement with respect
thereto, as well as, any and all claims of whatever kind and nature which I
have or may have against him arising from the ___(event)___;

In view of the said payment, I do hereby release, discharge and waive

any and all actions of whatever nature, expected, real or apparent, which I
may have against _____________ by reason of or arising from the said
vehicular incident. I will institute no action, whether civil, criminal, labor, or
administrative against _________. Any and all actions which I may have
commenced, either solely in my name or jointly with others before any
office, board, bureau, court, or tribunal against ______________, is hereby
deemed and considered voluntarily withdrawn by me and I will no longer
testify or continue to prosecute said action.

I do further declare that I have read this document and have fully
understood its contents and that this Release, Waiver and Quitclaim is
voluntarily and willingly executed, with full knowledge of my rights under
the law.

That I am executing this instrument freely and voluntarily without any

moral or physical threat, coercion or promise of reward in any form.

IN WITNESS WHEREOF, I hereby affixed my signature this ___ day

of __(date)__ in __(place)__, Philippines.

______________
AFFIANT

SIGNED IN THE PRESENCE OF

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 _______________________ ______________________

SUBSCRIBED AND SWORN to before me this ____ day of July,

20__, in the City of ________, affiant exhibiting to me and presenting
competent evidence of his ___________ with No. ___________, issued by
_______________ with expiry date on __________.

Doc. No.__________;
Page No. _________;
Book No._________;
Series of 20___.

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