DEED OF RELEASE, WAIVER AND QUITCLAIM

I, , of legal age, Filipino, and a resident of Upper, Philippines, hereby DECLARE AND
MANIFEST:

That for and in consideration of the amount of EIGHTY-NINE THOUSAND FIVE

HUNDRED FIFTEEN PESOS (Php 89,515) in cash, in hand received by me to my full
and complete satisfaction, and the payment and settlement by of the expenses incurred
by damages sustained by my motorcycle, I, hereby absolutely release, completely clear,
and forever discharge the said person from any action, cause of action, sum of money,
liability, damages, claims and demands whatsoever, which in law or in equity I hereafter
may have upon or by reason of the injuries sustained by me, and the damage sustained
by my motor vehicle with MV File No. arising from the accident which happened on 02
April 2019 with the intention to completely and absolutely waive all my right of action,
causes of action, claims and demands, of whatever nature, arising from, or in connection
with the aforementioned accident.

I further warrant that I will institute no further action against arising from, by reason of,
or in connection with, the aforementioned vehicular accident. I also manifest that the
said payment / settlement made by the said person shall not be taken by me as a
confession and/or admission of liability on the part of the said person in connection with
the aforementioned accident.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ at

_____________, Philippines.

Affiant

Subscribed and sworn to before me this ___________ at, affiant exhibiting to me his
________________.

Doc No. ____

Page No. ____
Book No. ____
Series of 2019.