Republic of the Philippines

Municipality of Liloan

RELEASE, WAIVER AND QUITCLAIM

We, the signatories below, do acknowledge that Mr. ____________ is also a victim of the fraud
perpetrated by Mr. ____________. That as a sign of goodwill, Mr. ____________ returned the
money that we directly paid to Mr. ____________ in order not to tarnish the name and reputation
of the former. However, we know for a fact that Mr. ____________ has nothing to do with the
illegal act committed by the Mr. ___________. In addition, Mr. ____________ clearly explained
to us that he is doing this not because he is acknowledging any guilt whatsoever.
Thus, we do by these presents acknowledge receipt of the sum listed below in Philippine
Currency from Mr. ____________ as full and final payment of the money we paid Mr.
__________. In consideration of said payment, we do hereby release, discharge and waive any
and all actions of whatever nature, expected, real or apparent, which we may have against Mr.
____________. Moreover, we further subrogate Mr. ____________ our rights to demand and
prosecute our claim against Mr. ____________, who is the responsible party.
Lastly, we declare that we have read this document and have fully understood its contents. We
further declare that we voluntarily and willingly executed this Release, Waiver and Quitclaim
with full knowledge of our rights under the law.
Name
Address
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________

Date
________

Amount
__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

Signature

________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________
________________ ____________________
____________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________

________

__________