RELEASE WAIVER AND QUIT CLAIM

KNOW ALL MEN BY THESE PRESENTS:

That I, JESSA MAY DELA RAMA, Filipino, of Working Children Age under Republic Act 10361 or Batas
Kasambahay, and resident of Brgy. Naungan, Ormoc City, after having been duly sworn in accordance with law, hereby
acknowledge that after having been granted the benefits of due process as required by law, my services with MR.
ROLANDO C. PERALTA AND MRS. MICHELLE FRANCES C. PERALTA (herewith “the Employer”) were duly terminated on
September 07, 2013 for just and valid cause.

That the reason for the termination of my service was due to misconduct and willful disobedience of the
lawful order of my employer in connection with my duties and responsibilities (sinasadyang hindi pagsunod sa mga
alituntunin ng aking amo patungkol sa aking trabaho), habitual neglect or inefficiency in the performance of duties
(paulit-ulit na hindi pag gawa ng tama ng mga gawain sa bahay), willful breach of the trust reposed by the employer
on me thru several instances of telling a lie (sinasadyang pagsira ng tiwala ng amo dahil sa sunud sunod na
pagsisinungaling), commission of a crime or offense against an immediate member of the employer’s family via loss of
valuables /cash (komisyon ng pagkakasala sa isang miyembro ng pamilya sa pagkakawala ng pera), that within the
duration of my employment that I was treated fairly and just in accordance with Republic Act 10361 (na sa panahon ng
aking paninilbihan, ako ay trinato ng tama at naayon sa Batas Kasambahay) and that I was in a safe and healthy home
(at na ako ay nasa isang ligtas at maayos na tirahan).

Further, I acknowledge receipt from the Employer the amount of ____________ as final payment and full
and complete satisfaction of all amounts that are now or in the future due me from the Employer on account of my
employment/engagement therein and/or termination of my services there from.

In consideration of said payment, I do hereby quitclaim, release, discharge and waive any and all actions of
whatever nature, expected, real or apparent, which I may have against the Employer, its family members, relatives,
friends and acquaintances by reason of or arising from my employment with the Employer. I will institute no action,
whether civil, criminal, labor or administrative against the Employer, its family members, relatives, friends and
acquaintances. Any and all actions which I may have commenced either solely in my name or jointly with others before
any office, board, bureau, court, or tribunal against the employer, its family members, relatives, friends, and
acquaintances are hereby deemed and considered voluntary withdrawn by me and I will no longer testify or continue
to prosecute said action(s).

I declare that I have read this document and that this was fully explained to me and have fully understood its
contents. I further declare that I voluntarily and willingly executed this Release, Waiver and Quitclaim with full
knowledge of my rights under the law.

Nabasa at napaliwang sa akin ang lahat ng nakasaad sa dokumentong ito at na na-iintindihan ko ang lahat ng
nakasaad at nakasulat sa sinumpaang salaysay na ito at kusang loob ko itong ni-lagdaan.

IN WITNESS WHEREOF, I have hereunto set my hand at Mandaluyong City, this 7th day of September, 2013.

_____________________________
JESSA MAE DELA RAMA

SIGNED IN THE PRESENCE OF

_______________________ ______________________