1

Republic of the Philippines }

City of Manila } SS.

RELEASE WAIVER AND QUITCLAIM

I, HAROLD FREDRICH P. CANOY, Filipino, of legal age, with residence at 53 Plaridel

Street, Brgy. Dona Aurora, Quezon City, having been sworn in accordance with law, hereby
depose and state that:

1. On 11 August 2022 I figured in an accident when I bumped a motor vehicle driven by

WILLY A. DE ASIS, and registered under the name of COYHAM
TRANSPORTATION and MERRIAM P. TANCHICO. I hereby declare that the the
accident was of no fault to anyone. It is a pure accident and no person involved
therein may be held liable, whether civil, criminal or administrative.

2. Considering this, I do hereby quitclaim, release, waive and forever discharge WILLY
A. DE ASIS, COYHAM TRANSPORTATION and MERRIAM P. TANCHICO from
any and all actions of whatever nature, expected, real or apparent, whether civil,
criminal or administrative, by reason of or arising from the above-mentioned
accident. 

3. I will institute no action, whether civil, criminal, or administrative against WILLY A.

DE ASIS, COYHAM TRANSPORTATION and MERRIAM P. TANCHICO.  Any and
all actions which I may have commenced either solely in my name or jointly with
others before any office, board, bureau, court, or tribunal against respondents, its
directors, officers, employees, agents and clients are hereby deemed and
considered voluntary withdrawn by me and I will no longer testify or continue to
prosecute said action(s).

4. Further, I would like to acknowledge receipt of PhP25,000.00 WILLY A. DE ASIS,

COYHAM TRANSPORTATION and MERRIAM P. TANCHICO as financial
assistance Said assistance is not a form of settlement but merely a gratuity to aide
me. Further, I will not expect nor demand any further amount the said individuals, nor
institute any action to, directly or indirectly, demand any further sum. Said amount is
a complete financial assistance and shall be deemed to cover everything needed by
me arising from the accident that occurred on 11 August 2022.

5. I have read this document and have fully understood its contents.  I further declare
that I voluntarily and willingly executed this Release, Waiver and Quitclaim with full
knowledge of my rights under the law.

            IN WITNESS WHEREOF, I have hereunto set my hand this ______________

.
 2

HAROLD FREDRICH P. CANOY

Affiant

SIGNED IN THE PRESENCE OF

_______________________        ______________________

SUBSCRIBED AND SWORN TO, before me, Affiant appeared and exhibited his
government ID, having been examined by me personally and I hereby certify that he understood
the contents of the foregoing document and voluntarily executed the same.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022;