Republic of the Philippines)

RELEASE, WAIVER AND QUITCLAIM

ON PRODUCTS

I, __________________________________________, of legal age, Filipino,

presently residing at __________________________________________________, after

having been duly sworn to in accordance with law, do hereby depose and state that:

1. I am the customer of _____________________________________.

2. I make my purchases on ________________, with the following

items_________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________________________________.

3. I received from ____________________________ the item that I purchased on the

aforesaid date, and such items are all in good condition and have no defects.

4. I acknowledge that whatever fault/damage to the items made by my

Contractor/installation personnel during the installation process cannot be accounted
for or ask for any warranty to the seller of the said items in which it was received with
no defects.

5. I further agree that this Release, Waiver and Quitclaim may be pleaded in bar to any
suit or proceeding to which either I and my heirs and assigns, may have against the
seller.

6. I declare that the release, waiver and quitclaim hereby given is made willingly and
voluntarily and with full knowledge of our rights under the laws.

IN WITNESS WHEREOF, I have executed this instrument this day of

2023 at _____________________.

__________________________
Affiant/Customer

SUBSCRIBED AND SWORN to before me this _______day of _____________, 2023 at

_______________________, Affiant exhibiting to me his/her Valid Identification
_____________________________issued at _____________on _____________________.

NOTARY PUBLIC

Doc. No. _______

Page No. _______
Book No._______
Series of 2023.