DEED OF RELAESE, WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, ____________ Filipino, of legal age, and a resident of __________,

Philippine, hereby DECLARE AND MANIFEST THAT:

I acknowledged receipt of the sum, in cash, of __________ (PhP______),

duly given and in hand received by me on ______, to my full and complete satisfaction,
from __________, as FINANCIAL ASSISTANCE for the death of ________, as a result
of a vehicular accident which transpired on ________ at ______, to which the said
personnel of 7FSSU, ASCOM is not at fault, hence is completely free from any liability.
This is so since the said incident is purely an accident and unintentional arising from the
circumstances such that any of the personnel of the Command has no control or
influence whatsoever.

I hereby absolutely release, completely clear, and forever discharge

____________ 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 I, my or the
victim’s heirs, insurer, successors and assigns hereafter may have upon or by reason of
the aforementioned accident.

I further warrant that I will institute no further action against ________,

7FSSU, and ASCOM, including its personnel, 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 me, my/his heirs, my/his insurer or assigns, as a
confession and/or admission of liability on the part of the said _____________ or by the
unit, in connection with the aforementioned accident.

I declare that I have read this document and have fully understood its
contents. 

I further declare that I voluntarily and willingly executed this Release, Waiver
and Quitclaim with full knowledge of my rights under the law.

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

_____ day of ______________ 2021.
 

_____________________
Affiant

SIGNED IN THE PRESENCE OF

_____________________        __________________________
(WITNESS) (WITNESS)

REPUBLIC OF THE PHILIPPINES)

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City of Cebu) S.S.
x-----------------------x

ACKNOWLEDGEMENT
 
BEFORE ME, this ______ day of _________ 2021 in the City of Cebu,
personally appeared:
 
NAME IDENTIFICATION CARD DATE ISSUED
NUMBER PLACE ISSUED

known to the witnesses and to me known to be the same persons who executed the
foregoing instrument and acknowledged to me that the same is their free and voluntary
act and deed.

This instrument, consisting of TWO (2) pages, including the page on which
this acknowledgement is written, has been signed on the left margin of each and every
page thereof ___________________ and his witnesses, and sealed with my notarial
seal.
 
WITNESS MY HAND AND SEAL, on the date and place first above written.

                                                                  

NOTARY PUBLIC

Doc. No.: _____

Page No.: _____
Book No.: _____
Series of 2021.

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