RELEASE, WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, __________________________, Filipino, of legal age and a

resident of _____________, hereby DECLARE AND MANIFEST:

That for and in consideration of the amount of _____________

(P_____________) in cash, in hand received to my full and complete
satisfaction, and the payment and settlement by _____________ of the
expenses incurred by the _____________ for the damage to my motor
vehicle, I hereby absolutely release, completely clear, and forever
discharge the said _____________ and his driver _____________ from
any action, cause of action, sum of money, liability, damages, claims
and demands whatsoever, which in law or in equity I have, or which
my heirs, insurer, successors and assigns hereafter may have upon or
by reason of the damage sustained by my motor vehicle with Plate
No. ______________ arising from the accident which happened on
_____________ at _____________ involving our said _____________
registered in the name of the undersigned _____________ and the
_____________ motor vehicle with Plate No. _____________ owned by
the said _____________ 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

the said _____________ and/or his driver _____________ 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 _____________ shall not be taken by us, our heirs,
our insurer or assigns, as a confession and/or admission of liability
on the part of the said _____________ or by his driver _____________
in connection with the aforementioned accident.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________ at _____________, Philippines.

AFFIANT
 SIGNED IN THE PRESENCE OF:

__________________ __________________

(ACKNOWLEDGMENT)