Pizza LaRoma

Aparente St. Block 7, Brgy. City Heights,

General Santos City
0907-2147837 / 0917-1457935 /
083-3063230
www.facebook.com/pizzalaromagensan

Republic of the Philippines)

Province of ____________________) S.S.
City/Municipality of _____________)
x––––––––––––––x

WAIVER, RELEASE AND QUITCLAIM

I, ____________________, Filipino, of legal age, (single / married / widow), and a resident of

____________________, Philippines, after being sworn to in accordance with law, depose and state:

1. That by these presents, I hereby state that I have voluntarily resigned as ______________(Position) of Pizza
LaRoma;

2. 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 set my hand this _____________ at _____________, Philippines.

________________________
Affiant