Republic of the Philippines ) S.S.

City of Mandaue )

UNDERTKING WITH WAIVER

AND QUITCLAIM

I, _____________________________________, Filipino, of legal age, (single / married

/ widow), and a resident of _____________, Philippines, after being sworn to in
accordance with law, depose and state:

1. That by these presents, I hereby state that I am the owner of the

house erected on the lot property of ___________________________
situated at________________________________;

2. That I have occupied the said property since ______ knowingly fully
that I am not the owner of the aforementioned property;

3. That I undertake to leave the property on _______________________ and

hereby voluntarily surrender the same property to the true and
registered owner peacefully without any reservation;

4. That I hereby acknowledge to have received from the registered owner

the sum of __________________________ (P_____________) in
consideration of the said reconveyance, surrender and transfer of
possession of the said property to the lawful and legal owner;

5. That I hereby declare that I have no further claims whatsoever against

the registered owner, his heirs, assigns and successors and that I
hereby release and forever discharge all of them from any and all
claims, demands, cause of action of whatever nature arising from the
reconveyance of the possession of the property to the latter;

6. I further agree that this UNDERTAKING WITH WAIVER, RELEASE

AND QUITCLAIM may be pleaded in bar to any suit or proceeding IN
ANY COURT, tribunal or quasi-judicial agencies to which either I, or
my heirs and assigns, may have against the owner in connection with
the said surrender, release and transfer of possession of the said
property with the latter and that the payment which I have received
as provided herein should not in any way be construed as an
admission of liability on the part of the owner and is voluntarily
accepted by me and will, if need be, serve as full and final settlement
of any amount(s) due me or any claims or cause of action, either past,
present, future, which I may have in connection with my prior or
previous possession of the property;
 7. As such, I finally make manifest that I have no further claim(s) or
cause of action against the owner nor against any person(s) and
forever release the latter from any and all liability.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________

at _____________, Philippines.

Affiant

BEFORE ME, this ________________________, at ____________________,

personally appeared ______________________________, who made him/herself
known to me to be the same person who executed the foregoing instrument,
and he/she acknowledged to me that the same is his/her own free and
voluntary act and deed.

WITNESS MY HAND AND SEAL, on this ______________________, at the

place first above written.