AFFIDAVIT OF RELEASE AND QUITCLAIM WITH INDEMNITY UNDERTAKING

I, ____________________________, of legal age, married, Filipino, and resident of

______________________________________________, under oath, hereby declare and state that:

I/We are the only heir/s of the deceased name of demised client, who died intestate on
___________________________ at _________________________.

For and in consideration of my/our receipt of the amount of

_________________________________________________________________________________________,
(____________________), representing proceeds of (type of account ) with Account Number
______________________ of the Deceased with BDO Unibank Inc.- Cebu IT Park TGU
Tower Branch (the “Account”), I/we hereby expressly and absolutely remiss, release and forever discharge
BDO Unibank Inc., its owners, directors, stockholders, officers, employees and assigns (collectively,
“BDO”)from any and all claims, suits, actions or causes of action which I/we, my/our successors/ assigns now
have or in the future claim to have against BDO in connection with the Account.

We understand that the above-stated amount represents net proceeds of the Account after the following
deduction:

6% final withholding tax Php______

I/We hereby undertake that we will comply with all the requirements for extrajudicial settlement of
estates under Rule 74 of the Rules of Court, or otherwise settle the estate of the Deceased in accordance with
law.

I/we hereby further obligate myself/ourselves, jointly and severally to indemnify BDO for any loss or
damages which it may sustain in the event that any third person/s shall succeed in establishing a right
superior to that of mine/ours concerning the Account.
3.

FURTHER AFFIANT/S SAYETH NAUGHT.

_______________________ _______________________ _______________________

Affiant Affiant Affiant

Subscribed and sworn to before me, this ___________ day of ________________ 20______
at _________________________________ affiant/s exhibiting to me his/her/their
_________________________________ (Competent Evidence of Identity) issued on _______________ at
___________________ and valid until _________________.

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of _________