RELEASE OF CLAIM

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FOR THE SOLE CONSIDERATION OF _______________________________________________________

(P____________) the receipt whereof is hereby acknowledged, I, Ivy Landicho Alburo, for ourself, our heirs,
representatives, successors, and assigns, do hereby release and forever discharge Wally Villabroza Aguilar / Jean
Dones Aguilar / Pioneer Insurance & Surety Corporation, and/or whoever may be held liable for their acts, of and from
all actions, claims, demands and rights of actions whatsoever that now exist or may hereafter develop and particularly
on account of all known, unknown and anticipated injuries, damages and/or losses arising out of and as a
consequence of an incident which occurred on October 2, 2022 at about 11:30 p.m. along Barangay Sampaloc 2,
Sariaya, Quezon.

I/We further agree that this payment is voluntarily accepted as a full and final compromise, adjustment and
settlement of all claims and that the payment of said amount shall be never construed as an admission of all liability by
the party or parties hereby released.

I/We further agree that __________________________________________ is/are subrogated to all my/our

rights of recovery on all claims, demands and rights of actions on account of loss, damage or injury as a consequence
of the accident hereby above-mentioned from any person, persons, corporations or whomsoever maybe liable
therefore, that I/we further agree to assist and hereby authorized the said ___________________________ to begin
suit, prosecute, compromise and withdraw either in our names or in their names, all legal proceedings which they may
seem necessary to enforce my claim or claims.

I/We manifest that the terms of this RELEASE have been read and are thoroughly understood.

IN WITNESS WHEREOF, We have set our hand(s) and seal this _____ day of _______________________,

READ CAREFULLY BEFORE SIGNING

Ivy Landicho Alburo

Affiant

SIGNED IN THE PRESENCE OF :

_____________________________ ___________________________

REPUBLIC OF THE PHILIPPINES)

CITY OF ___________________) S.S.

Personally appeared before me this _______ day of ________________________ with Residence Certificate No.
___________________ issued at ___________________ on ____________________ who executed the above
RELEASE, and acknowledged the same to be his/her free act and deed; and I certify that before the execution thereof, the
said RELEASE was read over and fully explained to the same person(s) by me and that he/she declared before execution
thereof that he/she fully understood the same.

Notary Public
Until December 31 ___________

Doc. No. _______

Page No. _______
Book No. _______
Series of _______