REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN) S.S.

AFFIDAVIT OF COMPENSATION, WAIVER & QUITCLAIM

I, ________________________, Filipino, of legal ages, married/single, and

resident of Pantudlan, Cabilao Island, Loon, Bohol, Philippines, after having been duly
sworn to in accordance with law hereby depose and say:

1. That I have been employed with __________ as ___(position)___, for the

period __________ to ___________;

2. That I am aware that the owner of the said _____________,

_______________, recently _____ the said _______ because of the non-feasibility of
further operations and declining sales;

3. That despite the losses she incurred in the operation of the ______, the owner
voluntarily compensated me with the amount of _____________________ as my
separation pay;

4. That I hereby acknowledge having received the amount stated in paragraph 3

above at the time of the execution this contract of my own volition;

5. That I am also made aware that by my acceptance of the said amount, I would
hereafter waive all rights, that are due to me by reason of my previous employment with
___________________________;

6. That being of sound and disposing mind, and having been fully apprised of the
consequences of executing this sworn statement, I hereby state under oath that by these
presents I heretofore waive, renounce, relinquish and forever quitclaim, any and all rights
that have accrued in my favor relevant to my employment with _________, including,
but not limited to, backwages, salary deferentials, entitlements, emoluments, and other
such benefits conferred by the Labor Code of the Philippines, SSS, Pag-Ibig, Philhealth
and others;

7. That I am executing this affidavit without due force and intimidation, with full
understanding of the consequences of my action;

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

____________________ 2020, in Tagbilaran City, Bohol, Philippines.

__________________________________________
Affiant

SIGNED IN THE PRESENCE OF:

_________________________ __________________________

SUBSCRIBED AND SWORN TO before me this _________________ day of

________________ 2020 , in Tagbilaran City, Bohol, Philippines, affiant exhibited to
me hi/her competent proof of identity as written below his/her name.
Doc. No. ______
Page No. ______
Book No. ______
Series of _______
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