Republic of the Philippines }

Makati City } S.S

AFFIDAVIT OF WAIVER, RELEASE AND QUITCLAIM

I, ______________, of legal age, Filipino citizen, and residing at ___________________

City, after having been duly sworn to in accordance with law, hereby depose and state that:

1) I have been employed as ______________ with _________________ and

for reasons personal to me, I filed a

2) For and in consideration of the sum of _______(PhP________.00) as financial

assistance and full settlement of all my claims, such as, but not limited to, constructive
dismissal, non-payment of thirteenth month pay service incentive leave, salary deductions,
refund of cash bond, moral and exemplary damages and attorneys fee, I hereby forever release
and discharge_________________________, its Board of Directors and all their officers and
employees form any/all possible claims such as but not limited to illegal dismissal, non-payment
of thirteenth (13th) month pay, service incentive leave, salary deductions, refund of cash bond,
moral and exemplary damages and attorneys fee, as may be due me in connection with my
past employment. In relation to this AFFIDAVIT OF WAIVER, RELEASE AND QUITCLAIM, I
hereby acknowledge receipt of ________________(___) with Check No. ________ dated
_____________2010, issued by ________________________, payable to my order in the
amount of _______________Pesos (PhP_____________.00).

3) I make this AFFIDAVIT OF WAIVER, RELEASE AND QUITCALIM with the

acknowledgement and admission that ____________________________, its Board of
Directors, officers and employees are no longer liable to me for any and all claims and
obligations in connection with my employment that I am no longer interested in resuming. I
have no further claims, demands or suits of whatsoever nature and hereby waive any and all
claims or demands, monetary or otherwise against, ________________, it’s Board of
Directors, and all their officers and employees. This Affidavit is executed freely, voluntarily and
of my own accord, to attest the truth of the foregoing facts and for whatsoever legal intents
and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of December
2010.

______________________
Affiant

SUBSCRIBED AND SWORN TO before me in Makati, this _____ day of December

2010, affiant exhibiting to me her Passport No. ________ issued at Manila on ______________
and Driver’s License No. ______________ issued at Manila by the Land Transportation Office.

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2010.