_________(company)__________

RECEIPT, RELEASE, WAIVER

QUITCLAIM AND UNDERTAKING

KNOW ALL MEN BY THESE PRESENTS:

This is to certify that I, ___________________, of legal age, Filipino citizen, with

residence and postal address at ____________________________________________,
for and in consideration of THIRTEEN THOUSAND EIGHT HUNDRED FIFTY
SIX & 25/100 PESOS (P13,856.25)*, to me in hand and actually paid and received by
me do hereby and by these presents, hereby forever RENOUNCE, RELEASE, WAIVE
and QUIT all further claims, charges, and causes of action, obligations and/or liabilities
whatsoever, that I may or might have against __________________________ or any of
its officers and/or directors arising out of or in connection with my employment therein.

This Receipt, Release, Waiver, Quitclaim and Undertaking shall apply to all
further claims, charges and causes of action that I might have against my employer,
whether it would be in the past, in the present, or in the future and shall be a valid
document of defense in the Civil Courts, the Department of Labor & Employment, and
before any other tribunal wherein my employment or work is being pursued as a cause of
action.

Further, I hereby acknowledge that in the course of my employment, confidential

information, trade secrets and technical matters have come into my knowledge. By this
declaration, I hereby give this unconditional undertaking that the above information,
secrets and technical matters shall not be divulged to any third party without the express
prior written consent of _______________________. its officers and/or directors.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of March

2021 at ___________ City.

______________________
AFFIANT

Signed in the presence of:

______________________ _________________________

REPUBLIC OF THE PHILIPPINES)

____________________ )) s.s.

SUBSCRIBED AND SWORN to before me this 4th day March 2021; Affiant
exhibited to me his/her valid proof of identity, ____________ issued on ____________ at
_____________.

Doc. No.: ____

Page No.: ____
Book No. ____
Series of 2021

*
SEE ATTACHED COMPUTATION