EMPLOYEE WAIVER, RELEASE, AND QUITCLAIM

REPUBLIC OF THE PHILIPPINES )

_ ) SS.

I, _, Filipino, of legal age, single/married to /widow/widower, and a resident of _, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am an employee of _, having connected therewith as _, since _;

2. That I have a letter of resignation with the company effective _;

3. 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 affixed my signature this day of 20_ at , Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _ this day of 20_. The affiant, whom I identified
through the following competent evidence of identity: _, valid from to issued by , personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument.

Notary Public

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