Waiver Release and Quitclaim)

Republic of the Philippines)

Province of ____________________) S.S.
City/Municipality of _____________)
x--------------x

WAIVER, RELEASE AND QUITCLAIM

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

_____________, Philippines, after being sworn to in accordance with law, depose and state:

1. That by these presents, I hereby state that I have voluntarily resigned as __Position Held__ of
__Employer__;

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

__________________________ (P_____________) 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;

3. 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;

4. 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;

5.As such, I finally make manifest that I have no further claim(s) or cause of action against my
employer nor against any person(s) 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

(JURAT)