AFFIDAVIT OF RELEASE AND QUITCLAIM WITH INDEMNITY UNDERTAKING

I/we ________________________________________, all of legal age, <civil status> Filipino, and

resident/s of _____________________________________________, under oath, hereby declare and
state that:

1. I/we am/are the heir/s of the deceased__________________________, who died intestate on

_________________________at____________________________(the “Deceased”).

2. For and in consideration of my/our receipt of the amount of ____________________________,

(Php_______________), representing proceeds of <savings/current/time deposit> no.________
of the Deceased with BDO Unibank, Inc.- _______________ Branch (the “Account”), I/we hereby
expressly and absolutely remiss, release and forever discharge BDO Unibank, Inc., its owners,
directors, stockholders, officers, employees and assigns (collectively, “BDO”) from any and all
claims, suits, actions or causes of action which i/we, my/our successors/ assigns now have or in
the future claim to have against BDO in connection with the Account.

3. I/we hereby further obligate myself/ourselves, jointly and severally to indemnify BDO for any
loss or damages which it may sustain in the event that any third person/s shall succeed in
establishing a right superior to that mine/ours concerning the Account.

FURTHER AFFIANT SAYETH NAUGHT.

______________________________________
Affiant/s

Subscribed and sworn to before me, this _____________day of _____________2016 at

_____________________________ affiant/s exhibiting to me his/her/their
_________________________________________ (Competent Evidence of Identity) issued on
___________ at _______________and valid until ______________.

NOTARY PUBLIC

Doc No.
Page No.
Book No.
Series of 2016