Republic of the Philippines)

Province of Bulacan )S.S.

Municipality of Sta. Maria )

WAIVER, RELEASE AND QUITCLAIM

I, _____________________________________, Filipino, of legal age, married, 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 resigned as __________________ of
__________________________________________________;

2. That I hereby acknowledge to have received from my employer the sum of

_________________________________________________ (_____________________) which is in full and
final satisfaction of my salary and other benefits that may be due me for the service which I have rendered for the
latter employer;

3. That I hereby declare that I have no further claims whatsoever against my employer, 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 my employment with the latter;

4. I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded in bar to any suit or
proceeding (Civil, SSS, PhilHealth, Pag-ibig, Labor, etc.) to which either I, or my heirs and assigns, may have
against my employer in connection with my employment 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 my
employer 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
employment with my employer;

5. As such, I finally make manifest that I have no further claim(s) or cause of action against my employer
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

SIGNED IN THE PRESENCE OF:

_______________________________ _______________________________

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the Province of Bulacan, this ______ day of
_____________________________, personally came and appeared before me and exhibited to me his
competent evidence of identity consisting of ______________________________________________.

Known to me and to me known to be same person who executed the foregoing instrument and they
acknowledged to me that the same is their own free act of deed.

WITNESS MY HAND AND SEAL.

NOTARY PUBLIC

Doc. No. _____

Page No._____
Book No._____
Series of 2020.