CASE TITLE/CAPTION

QUITCLAIM AND RELEASE

(PAGTALIKOD AT PAGPAPAWALANG SAYSAY)

I, _____________________________________ of legal age residing at _____________________

(Ako) (nasa hustong gulang at nakatira sa)

___________________________________________________ for and in consideration of the amount of

(bilang konsiderasyon sa halagang)

_____________________________________________ (Php_________) do hereby release and

discharge
(ay aking pinawalang-saysay at
tinatalikdan)

aforesaid company/corporation and its officer/s, person/s from any money claim by way of unpaid
wages, separation pay, overtime pay or otherwise, as may due to me in connection with my past
employment with the aforementioned company/corporation, its officers/persons.
(ang nabanggit na kumpanya/korporasyon at ang mga tauhan nito mula sa anumang paghahabol na
nauukol sa pananalapi sa pamamagitan ng di nababayarang sahod, o anupaman na karadapt dapat
para sa akin na may kaugnayan sa aking huling pinapasukang kumpanya or korporasyon at sa mga
opisyales or tauhan nito).

I am executing this Quitclaim and Release, freely and voluntarily before this Office without any
force or duress.
(Isinagawa ko ang Pagtalikod at Pagpapawalang-salaysay na ito na may Kalayaan at kusang-
luob sa harapan ng tangapang ito ng walang pamimilit o pamumuwersa).

and as part of the settlement agreement reached during the conciliation-mediation process
conducted in the Office of Commissioner Agnes Alexis Lucero De Grano.
(at bilang bahagi ng napagkasunduan buhat sa proseso ng conciliation-mediation dito sa opisina
ni Komisyonado Agnes Alexis Lucero De Grano).

IN VIEW WHEREOF, I hereunto set my hand this ____ day of _____________, 2018 in Quezon
City.
(DAHIL DITO, ako ay lumagda ngayong araw ng _________________ sa Lungsod Quezon).

___________________________
Signature of the Requesting Party
(Lagda ng Partidong Humiling)
Attested by: __________________________
(Pinapatunayan ni) Signature over Printed Name
(Lagda sa Nakalimbag na Pangalan)