REPUBLIC OF THE PHILIPPINES)

CITY OF CAGAYAN DE ORO ) S.S.

AFFIDAVIT OF RELEASE AND QUITCLAIM

WITH INDEMNITY UNDERTAKING

I, ____________________, of legal age, widow, Filipino and a resident of

___________________, Philippines, after having been duly sworn to an oath in
accordance with law, hereby depose and state that:

1. I am the heir of the ______________________ who died intestate

on _______________ at ______________________;

2. For and in consideration of my receipt of the amount of

________________________, representing proceeds of Time
Deposit _______________ and Account No. ________________of
the Deceased with _____________________, I hereby expressly
and absolutely release and forever
discharge____________________., its owners, directors,
stockholders, officers, employees and assigns from any and all
claims, suits, actions or causes of action which I may now have or in
the future claim to have against ________________ in connection
with the said Account.

3. I hereby further obligate myself jointly and severally to indemnify

_____________________ for any loss or damages which it may
sustain in the event that any third person shall succeed in
establishing a right superior to that of mine concerning the Account.

FURTHER AFFIANT SAYETH NAUGHT.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this

_____________________________, affiant exhibited to me her
S________________ as her competent evidence of identity.