ACKNOWLEDGEMENT RECEIPT

Received from the ROSABELLE REI F. PRUDENTE, the total amount of SIX THOUSAN SEVEN
HUNDRED FORTY-FIVE PESOS and 60/100 ONLY (Php6,745.60), as the last payment of my
compensation for the last week of lost wages during my absence from work due to my recovery period as
evidenced by Affidavit of Waiver, Quitclaim and Release dated 15 February 2024 and notarized by Atty.
Pompeyo P. Maynigo with Doc. No. 199, Page No. 41, Book No. 11, Series of 2024.

This is to acknowledge that as of today, I have received from ROSABELLE REI F. PRUDENTE the
total and complete amount of THIRTY-SIX THOUSAND SEVEN HUNDRED FORTY-FIVE PESOS and
60/100 ONLY (Php36,745.60).

I have also received from ROSABELLE REI F. PRUDENTE an additional amount of

________________________ (Php_________), separate from the aforementioned sums and is intended
to cover my travel expenses from my second and last month of recovery period, that is, from 16 March
2024 to 12 April 2024 only.

It is also to be noted that the Addendum Affidavit of Waiver, Quitclaim, and Release (“Addendum
Agreement”) dated ____________ and notarized by ____________________________ with Doc. No. ___,
Page No. ___, Book No. ___, Series of ____ subsequent to the signing of the Affidavit of Waiver, Quitclaim
and Release dated 15 February 2024 (“Initial Agreement”) shall constitute an integral part of the Initial
Agreement. Both parties affirm that any provisions contained within the Addendum Agreement shall be
binding and enforceable to the same extent as if they were originally incorporated into the main body of the
Initial Affidavit.

This is to further acknowledge that I have received my complete lost wages during my actual
absence from work due to my recovery period amounting to THIRTY-SIX THOUSAND SEVEN HUNDRED
FORTY-FIVE PESOS and 60/100 ONLY (Php36,745.60), as well as additional amount of
________________________ (Php_________) representing my travel expenses from 16 March 2024 to
12 April 2024 only, or a total sum of ________________________ (Php_________). Hence, I have no
more claims, whether past, present or future against RENNET F. PRUDENTE and ROSABELLE REI F.
PRUDENTE and completely and absolutely exonerate them arising from, by reason of, or in connection
with the aforementioned vehicular accident.

______________________________
DANICA PANGILINAN DEOMAMPO

Conforme:

______________________________
ROSABELLE REI F. PRUDENTE

Date: ___________________
Annex “A”