DEED OF RELEASE, WAIVER AND QUITCLAIM

We, the spouses _________________ and ________________, both of legal ages,

Filipinos, and residents of _________________, Philippines, hereby DECLARE AND
MANIFEST:

That for and in consideration of the amount of ____________________________

(P_____________) in cash, in hand received by us to our full and complete
satisfaction, and the payment and settlement by _____________________ of the
hospital and medical bills and expenses incurred by the ___________________ for
injuries sustained, I, WE hereby absolutely release, completely clear, and forever
discharge the said _________________ and his driver __________________ from
any action, cause of action, sum of money, liability, damages, claims and demands
whatsoever, which in law or in equity I/we have, or which I/we, our heirs, insurer,
successors and assigns hereafter may have upon or by reason of the injuries
sustained by me/us, and the damage sustained by our _________________ motor
vehicle with Plate No. _____________________ arising from the accident which
happened on ____________________ at ___________ involving our said
______________________ registered in the name of the undersigned
_____________________ and the ___________________ motor vehicle with Plate
No. _____________ owned by the said __________________ with the intention to
completely and absolutely waive all our right of action, causes of action, claims and
demands, of whatever nature, arising from, or in connection with the
aforementioned accident.

I/We further warrant that I/we will institute no further action against the said
____________________ and/or his driver _______________________ arising
from, by reason of, or in connection with, the aforementioned vehicular accident.
I/We also manifest that the said payment / settlement made by the said
_______________________ shall not be taken by us, our heirs, our insurer or
assigns, as a confession and/or admission of liability on the part of the said
_______________________ or by his driver _____________________ in
connection with the aforementioned accident.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ at

_____________, Philippines.

AFFIANT AFFIANT

SIGNED IN THE PRESENCE OF:

__________________ __________________

(ACKNOWLEDGMENT)