WAIVER, RELEASE AND QUITCLAIM

I, , Filipino, of legal, (single/ married/ widow), and a resident of,

Pampanga , Philippines, after being sworn to in accordance with law, depose and state.

1. That by these presents, I hereby state that I have voluntarily resigned (or have been terminated)
as __________________ of _____________________________________________________.
2. That I hereby acknowledge to have received from my employer the sum of
_____________________________________(Php __________________) which is in full and
final satisfaction of my salary and other benefits that may be due me for the service which I have
rendered for the latter employer.
3. That I hereby declare that I have further claims whatsoever against my employer, its President,
members of the Board, officers, or any of its staff and/or any of its clients and their officers and
employees; and that I hereby release and forever discharge all of them from and all claims,
demands, cause of action of whatever nature arising out of my employment with the latter.
4. I further agree that this WAIVER, RELEASE AND QUITCLAIM 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 or any of its clients in connection with my employment
with the latter 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 my employer and is voluntarily
accepted by me and will, if need be, serve as full and final settlement of any amount so due me or
any claims or cause of action, either past, present, future, which I have in connection with my
employment with my employer.
5. As such, I finally make manifest that I have no further claim(s) or cause of action against my
employer or 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

Signed in the presence of: _________________________________________

SUBSCRIBED AND SWORN to in ____________________, Philippines this ___________ day of

________, 20__ by the affiant with ______________ issued at ____________________ on
______________, 20____.

Doc. No. _______; Page No. __________;

Book No. _______; Series of 20_____;