Republic of the Philippines)

City of _____________) S.S.

x--------------x

WAIVER, RELEASE AND QUITCLAIM

I, _________________________________________, Filipino, of legal age, 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 have voluntarily waived any future claims;
2. That I hereby acknowledge to have received from the HOE the sum of
__________________________ (P_____________) which is in full and final satisfaction of
my monetary claims during the fire incident happen in 1704 17th flr., Summit One Tower;
3. That I hereby declare that I have no further claims whatsoever against HOE, its President,
members of the Board, officers or any of its staff and that I hereby release and forever discharge
all of them from any and all claims, demands, cause of action of whatever nature arising out of
monetary assistance with the latter;

4. I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded in bar to
any suit or proceeding (Civil, Administrative, Criminal or other lawsuit, etc.) to which either
I, or my heirs and assigns, may have against the HOE in connection with the Fire incident
happen that prejudices my current situation 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 HOE 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 all my claims from the company;
5. As such, I finally make manifest that I have no further claim(s) or cause of action against
HOE nor against any person(s) connected with the administration and operation of the latter
and forever release the latter from any and all liability.

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

_____________, Philippines.

_________________________
Affiant

Subscribed and Sworn to before me this ____ day of __________________, 2019 at

_______________ by the affiant who exhibited to me his __________________.

Notary Public
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of. 2019: