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_________________________ ) S.S.
ACKNOWLEDGEMENT RECEIPT
AND RELEASE, WAIVER, AND QUITCLAIM
In consideration of said payment, I hereby quitclaim, release, discharge, and waive any and all
actions of whatever nature, expected, real or apparent, which I may have against PHOENIX and its
directors, corporate officers, and employees. I will institute no action, whether civil, criminal, or
administrative against Phoenix and its directors, corporate officers, and employees. Any and all actions
which I may have commenced either solely in my name or jointly with others before any office, arbiter,
court, or tribunal against PHOENIX and its directors, corporate officers, and employees are hereby
deemed and considered voluntarily withdrawn by me and I will no longer testify or continue to prosecute
said action(s).
I further declare that I voluntarily and willingly execute this Acknowledgement Receipt and
Release, Waiver and Quitclaim with full knowledge of my rights under the law.
_______________________
_____________________ _______________________
ACKNOWLEDGEMENT
WITNESS MY HAND AND SEAL on the date and at the place first written above.
Doc. No .__________;
Page No. __________;
Book No.__________;
Series of 2019.