Service AdvisorRepublic of the Philippines )

City of Quezon City ) S.S.

WAIVER AND QUITCLAIM

KNOWN ALL MEN BY THESE PRESENT:

I, ________________________________________, of legal age, Single, Filipino Citizen, holding

Passport No. _____________ and a resident of _____________________________________ after
having been sworn to law depose and say that:

1. I am a requested worker of with postal address

at .

2. That being selected / requested worker, I was informed by QRD International Placement,
Inc. of the said position and was asked to proceed with my documentation and processing.

3. Despite having passed my examination, I am not pre-screened and evaluated as to my ability

and capability by QRD International Placement, Inc. to the position being nominated for;

4. I also hereby declare that during the documentation and processing of my documents for
overseas employment, I did not pay whatsoever, in any amount, to QRD International
Placement, Inc.

5. In the event that problem will arise with regards to our employment with the said employer,
because of my incapability for the position called
for, QRD International Placement, Inc. will not be held responsible.

6. I am relieving QRD International Placement, Inc. of any responsibility and liability

whether civil, criminal, administrative, material, and financial or whatever may arise from the
continuance of the said overseas employment.

7. I am further waiving the right or benefits that may be accorded by law or contract in my
favor against the aforesaid agency in connection with my said employment abroad.

AFFIANT FURTHER SAYETH NAUGHT.

_____________________________
(Affiant)

Subscribed and sworn to me before this ____ day of ____ affiant exhibiting to me his passport with
serial number ____ issued at ____ on _______

Notary Public

Doc. No. __________

Page No. __________
Book No. __________
Series of 2020 __________