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REPUBLIC OF THE PHILIPPINES) ) S.S.

AFFIDAVIT OF QUITCLAIM/RELEASE
I, _____________________________________ Filipino, of legal age, single/married, and with residence address at ___________________________________________________________________ __________________, after having been sworn in accordance with law, do hereby depose and state that: 1. I have voluntarily and unconditionally ____________________________; resigned from _______________________ effective

2. I hereby acknowledge receipt of the sum in cash of _____________________________________ ___________________________________ PESOS (P___________). With my receipt of such amount, I hereby affirm, manifest and voluntarily declare that during the entire period of my employment with _______________________, I was paid and received in full all compensations, wages, salaries, commissions, bonuses, 13th-month pay, benefits and privileges due me or which I am entitled to under existing laws by reason of such employment, and the receipt thereof constitutes full and complete payment of and settlement for any and all claims of whatever kind and nature which I have or may have against said company, its officers, agents or assignees, thereby releasing _______________________, its agents, officers, and assignees from any and all liabilities and obligations towards me; 3. Furthermore, I manifest and voluntarily declare that I have no cause of action or claim whatsoever against _______________________, its officers, agents, or assignees. As a consequence thereof, I shall desist from filing any complaint, civil, criminal or administrative, against _______________________, its officers, agents, or assignees in, including but not limited to, all government/administrative agencies, departments, offices, quasi-judicial agencies, the courts and tribunals of the Republic of the Philippines. 4. I further manifest that during the entire period of my employment with _______________________, I have never met any disabling accident, arising out of or in the course of my duties thereat nor have I become sick or disabled because of such employment; 5. I declare finally that I have read the contents hereof fully and I completely understand the same and/or that the contents hereof have been fully read and explained in a language or dialect known to me before signing the same and this Affidavit of Quitclaim/Release is made voluntarily and willingly with full knowledge of my rights and privileges under the law; 6. I have executed the foregoing affidavit to attest to the truth of the facts hereinstated. AFFIANT FURTHER SAYETH NAUGHT. __________________________ AFFIANT WITNESSED BY: _________________________ _________________________

SUBSCRIBED AND SWORN to before me this ______ day of _____________ 200__, affiant exhibiting to me her/his C.T.C. No. ______________ issued on ___________________ at ____________________.

Doc. No. ______ Page No. ______ Book No. ______ Series of 200 ___

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