Republic of the Philippines)

Province of ____________________) S.S.

City/Municipality of _____________)
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 I have an existing account at GM Bank of Luzon Inc.,;

2. That I hereby acknowledge to have settled my obligation in the sum of

__________________________ (P_____________) which is in full and final
satisfaction of said obligation which may be due and demandable on the lapse of
the period stated in the Promissory Note;

3. That I hereby declare that I have no further claims whatsoever against

my GM Bank of Luzon Inc., , its President, members of the Board, officers or any
of its authorized agents, and that I hereby release and forever discharge GM
Bank of Luzon Inc., 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 or Criminal) to which either I, or
my heirs and assigns, may have against GM Bank of Luzon Inc., in
connection with my financial obligation with the latter and that the payment
which was counterpoised in the Promissory Note should not in any way be
construed as an admission of liability on the part of GM Bank of Luzon Inc., 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 GM Bank of Luzon Inc.,;

5.As such, I finally make manifest that I have no further claim(s) or cause
of action against GM Bank of Luzon Inc., 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.

____________________________________________________
Affiant

SUBSCRIBED AND SWORN to before me, this _____________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _____________ on _____________ and by _____________
who exhibited to me (his/her) Community Tax Certificate No. _____________
issued at _____________ on _____________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2021;

NOTARY PUBLIC