RELEASE, WAIVER AND QUIT CLAIM

For and in consideration of the payment of the sum of PESOS: FIFTY THOUSAND PESOS ONLY
(50,000.00) , representing:

ACDI MULTIPURPOSE COOPERATIVE

receipt of which is hereby acknowledge, I MA. SUSANA C. BAUTISTA of

legal age, Filipino and a resident of Blk J Lot 25 Christine Village Brgy. Biga, Tanza, Cavite
for all myself and on behalf of my legitimate
children/grandchildren/relatives/husband/wife, my heirs, assigns and successors in interest, do hereby
release and discharge the COOPERATIVE and all other persons having interest therein is thereby from
all claims, demands, courses of action, etc., that may arise there from and/or incidentally connected there-
with.

I/we hereby warrant that this Quitclaim may be pleade, as an absolute bar to any suit that either is now
pending or may be henceforth prosecuted concerning matters referred to in the preceding paragraph. And
in connection herewith, I promise to defend the right to answer all costs of suits, of the Cooperative and all
other persons having interest therein or thereby.

I/we further hereby warrant that I fully undestand the terms and conditions of this Quitclaim, that the effects
hereof have been explained to me in a language/dialect I understand; and that I have executed this document
voluntarily and of my free will and that I was not under fraud, mistake, undue influence, intimidation, violence
or any other vice of consent.

, this day of 20

MA. SUSANA C. BAUTISTA

Printed Name and Signature of Claimant
SIGNED IN THE PRESENCE OF:

Witness Witness

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

) S.S

BEFORE ME, this day of 20

personally came and appeared; with Res. Cert No.
issued at on known to
be the same person who executed the foregoing instrument and acknowledged to me that the same is his/
her own free act and voluntary deed; effected under the warranties referred to in the body of instrument.

WITNESS MY HAND AND SEAL ON THE DATE/PLACE FIRST ABOVE WRITTEN.

Doc No:
Page No:
Book No:
Series of :

ACKNOWLEDGMENT SLIP
Date:
I/we hereby acknowledge that I/we has received:

Check # Check Voucher# Date

Amount FIFTY THOUSAND PESOS ONLY P50,000.00
Name MA. SUSANA C. BAUTISTA