WAIVER AND QUITCLAIM

For and in consideration of the amount of ________________ (Php ________),

representing full payment and settlementfor damages realting to the vehicular incident involving
the vehicle of Mr. Angelo Puertollano, the undersigned accepts said amount freely, willingly and
voluntarily.

The undersigned further warrants that his acceptance of said settlement amount
represents complete settlement of any and all present and future claims of the undersigned and
those which he represents, and relieves Mr. Angelo Puertollano of any further responsibility to
them.

Done this ___ day of February, 2018 at ____________.

______________________________

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Angelo Puertollano