REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ILOCOS SUR )

WAIVER, RELEASE, AND QUITCLAIM

I, _________, of legal age, married, Filipino, and a resident of _____________, after

having been duly sworn in accordance with law, hereby deposes and states:

1. That I am the current worker of the agricultural land identified as Lot 123 with an area of
55, 555 sq.m. more or less, and situated at __________________.

2. That I hereby acknowledge to have received from the owners of the land thru their
representative, the sum of ONE HUNDRED THOUSAND PESOS (P100,000.00) which
is in full and final satisfaction of my rights that may be due me for working on the land
for many years;

3. That I hereby declare that I have no further claims whatsoever against the owners, their
successors and assigns, 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 right as
worker of the land;
 
4. I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded in bar
to any suit or proceeding to which either I, or my heirs and assigns, may have against the
owners 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 the owners 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 working on the land;

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_______________

_______________
Affiant
ID No. _____________
Issued on/at: ____________________________

SUBSCRIBED AND SWORN TO, Before me, this ______________ at ____________.

The Affiant with his competent evidence of identity as indicated below his name and
signature.