Republic of the Philippines)

Province of ____________________) S.S.

City/Municipality of _____________)
x--------------x

WAIVER ON SEPARATION PAY

I, ___________________________, Filipino, of legal age, __________ (single / married /

widow), and a resident of _____________, Philippines, after being sworn to in
accordance with law, depose and state:

I. That for the value I received from extending a loan, I hereby state that I have
voluntarily waived my right to collect or claim an amount of P ________________
(in words _____________ ) and such be for the account of RDCMC until such loan
be paid fully, thus terminating the purpose of this waiver.

II. That I hereby declare that I have no further claims on the said amount or
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;

III. I further agree that this WAIVER may be pleaded in bar to any suit or proceeding
(Civil, SSS, PhilHealth, Medicare, 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 amount I received on the said loan be deemed an advance
payment of my separation pay, in whole or in part, that would transfer any rights of
collection or claims to the Cooperative.

IV. As such, I finally make manifest that I have no further claim(s) or cause of action
neither against my employer nor against any person 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

_________________________
Signature above printed name