Unit 4 Southway Condominium corner Yakal and Mayapis St.

San Antonio Village Makati City

Tell No. 72942771

WAIVER, RELEASE AND QUITCLAIM

I, , Filipino, of legal age, (single / married / widow), and

a resident of , after being sworn to
in accordance with law, depose and state:

That I hereby acknowledge to have received from my employer the sum of

which is
in full and final satisfaction of my salary and other benefits that may be due me
for the service which I have rendered for the latter employer;

That I hereby declare that I have no further claims whatsoever against my

employer, its President, members of the Board, officers or any of its staff and
that I hereby release and forever discharge all of them from any and all claims,
demands, cause of action of whatever nature arising out of my
employment with the latter;
 

I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded in
bar to any suit or proceeding (Civil, SSS, PhilHealth, Medicare, Labor, etc.) to
which either I, or my heirs and assigns, may have against my employer in
connection with my employment with the latter and that the payment which I
have received as provided herein should not in any way be construed as an
admission of liability on the part of my employer 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 my employment with my employer;

As such, I finally make manifest that I have no further claim(s) or cause of

action neither against my employer nor against any person 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