REPUBLIC OF THE PHILIPPINES )

MAKATI CITY ) S.S.

ACKNOWLEDGEMENT RECEIPT, WAIVER & QUITCLAIM

I, ___________________________, of legal age, Filipino and with residence address at

__________________________________________, hereby acknowledge that I was an employee of
the (name of the corporation) [the “Corporation”] assigned as (indicate position in the company)
from (date of employment) until my resignation employment with the Corporation effective
on (date of effectivity of resignation). I hereby acknowledge receipt of PESOS _
___________________& /100 (PHP ___________) representing full and complete settlement of my
last pay, 13th month, service incentive leave cash conversion, completion bonus and all monetary claims,
receipt of which I hereby acknowledge to my complete and full satisfaction. (See attached breakdown).

ACCORDINGLY:

I hereby acknowledge that I have been paid by the Corporation all amounts that are due to me up
to the date of my termination from employment under the Labor Code.

I affirm and confirm that the management of the Corporation has explained to me the reasons for
the termination of my employment. To the best of my knowledge, Corporation has not committed any
discrimination of any kind against me or my fellow employees with respect to our employment in matters
of hiring, promotions, transfers and that I have not suffered any sickness as a result of my employment
with the company.

I hereby irrevocably and unconditionally release, acquit and forever discharge the Corporation,
and said corporation’s assigns, subsidiaries, affiliates, related entities, directors, officers, and
stockholders, from any and all liabilities, claims, suits, actions, damages, demands whatsoever, civil,
criminal or otherwise, which in law or in equity I may have in connection with my employment.

I undertake NOT to institute any suit, claim or action whatsoever, civil, criminal, labor,
administrative or otherwise, presently or in the future, and will not continue to prosecute pending actions,
if any, against the Corporation , its assigns, subsidiaries, affiliates, related entities, its directors, officers
and stockholders. This instrument may be pleaded as an absolute and final bar to suit or suits or legal
proceedings that I may hereafter prosecute against the Corporation, its assigns, subsidiaries, affiliates,
related entities, directors, officers and stockholders.

I hereby voluntarily undertake to desist from doing any and all acts inimical to the interests of the
Corporation, its affiliated companies, or other related entities, assigns, subsidiaries, affiliates, directors,
officers, and stockholders, including, but not limited to, the spreading of e-mail messages, or
dissemination of harmful messages in other forms of media, radio, or print, concerning the Corporation,
relating to, or in connection with the transactions mentioned above.

I hereby affirm that I have freely and voluntarily signed this document after having read and fully
understood its contents and further state that I have no more claim, right, action and demand of whatever
nature, whether past, present or contingent, against the Corporation, its assigns, subsidiaries, affiliates,
related entities, directors, officers, and stockholders.
 Affiant

SUBSCRIBED AND SWORN TO before me this _______ day ____________of 2019, Affiant
exhibiting to me his duly issued government Identification __________ Card No._______________.

Doc No. _______

Page No. ______
Book No. ______
Series of 2019.