(Waiver Release and Quitclaim)

Republic of the Philippines)

Province of Iloilo) S.S.
City/Municipality of Iloilo)
x--------------x

WAIVER, RELEASE AND QUITCLAIM

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of
_____________, Philippines, after being sworn to in accordance with law, depose and
state:
1. That by these presents, I hereby state that I have been validly reported as retrenched by
Xilium Professional Services Inc. (Employer);
2. That I hereby acknowledge to have received from my employer the sum of
__________________________ (P_____________) 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 no further claims 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;
 
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 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(s) due me or any
claims or cause of action, either past, present, future, which I may 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 nor against any person(s) 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.
___________________________________________________
Name/ Signature and Date

SUBSCRIBED AND SWORN to before me, this _____________, by _____________

who exhibited to me (his/her) _____________ with ID NO. _____________ issued at
_____________, Philippines on _____________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;