AFFIDAVIT OF UNDERTAKING,

RELASE, WAIVER AND QUITCLAIM

I, ROMINADA SALAC, of legal age, single/married, Filipino and with residence address
at ________________________, after having been duly sworn to in accordance with law,
hereby depose and state that:

1. I am the legal wife of ERNESTO BONDOC ESGUERRA, an employee of Sta.

Clara International Corporation (“SCIC”), who passed away on September 17, 2015;

2. As the legal spouse of the said deceased, I am entitled to claim from SCIC his
last pay, SSS Funeral Benefits and Employee Insurance Benefits which he is entitled to as
employee of SCIC under the latter’s company policy, rules and regulations;

3. As part of the conditions of SCIC to process the release of said employee

benefits, I guarantee that SCIC shall be relieved from any and/or whatever claims that the other
legal heirs of the said deceased may have in the said employee benefits;

4. It is understood by me that the release of the SSS Funeral Benefit and Employee
Insurance Benefit of my deceased husband is subject to approval of SSS and the Insurance
provider of SCIC. Thus, SCIC shall assist me in filing my application and/or claim with the SSS
and Insurance provider but SCIC does not guarantee that my claim and/or application will be
approved by the SSS and Insurance provider;

5. Upon receipt of the said employee benefits, I undertake to give and/or distribute
to the other legal heir/s of the deceased their proportionate share in the said employee benefits;

6. If any claim is made by the other legal heirs of the deceased with SCIC in
connection with the said employee benefits, I undertake to answer the same and relieve SCIC
from any such claim and/or liability;

7. If any action is brought by any of the legal heirs of the deceased in relation to the
said employee benefits upon release of the same to me by SCIC and the latter is made to pay
for the said claim/s, I undertake to pay for the same to the said claimants and release SCIC
from any liability;

8. Upon release by SCIC of the said employee benefits to me, I shall forever
release, waive and discharge SCIC, its subsidiaries or affiliates, its President, Members of the
Board, Officers or any of its staff from any and all claims, demands, cause of action of whatever
nature in connection with the said employee benefits;
 9. The said WAIVER, RELEASE AND QUITCLAIM may be pleaded as a bar to any
suit or proceeding to which either I, or my heirs and assigns, may have against SCIC, its
subsidiaries or affiliates in connection with the said employee benefits and that the payment
which I shall receive in connection with the said employee benefits, as provided herein, should
not in any way be construed as an admission of any liability on the part of SCIC to me or to the
deceased;

10. I am executing this Affidavit of Waiver, Release and Quitclaim freely and
voluntarily, to attest to the truth of the foregoing statements, as requirement of SCIC for the
release of the said employee benefits and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereto set my hand this _____ day of January 2016 at
Mandaluyong City.

MARIETTA C. ESGUERRA
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of January 2016 at

Mandaluyong City, affiant exhibited to me her NBI valid until November 10, 2016, as competent
proof of her identity bearing her photograph and signature.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2016.