RELEASE, WAIVER, AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, ______________, of legal age, Filipino, married, and with residential

address at _______________, after having been duly sworn to in
accordance with law, do hereby state and undertake as follows:

1. I acknowledge the receipt of One hundred thousand pesos

(P100,000.00) (the “Consideration”) from Dr. Nimfa Bautista;

2. I acknowledge the sufficiency of the Consideration as the sole

consideration for this Release, Waiver, and Quitclaim;

3. I acknowledge that the Consideration given by Dr. Nimfa

Bautista is her way helping me pay the hospitalization bills
that I incurred;

4. I voluntarily accept the Consideration for the purpose of

creating a full and final settlement of any and all claims for
any damages and injuries, or otherwise that may arise from
the incident that happened last _________

5. In view of the receipt of the Consideration, I hereby quitclaim,

waive, and discharge, forever and unconditionally, Dr. Nimfa
Bautista and/or her agents, representatives, and successors-
in-interest from any and all causes of actions, sums of money,
claims, damages, demands, and any further liability
whatsoever in law, contract, and equity, past, present, or
contingent, which I or successor-in-interest, representatives,
and assigns had, have, or may have against Dr. Nimfa
Bautista and/or her agents, representatives, and successors-
in-interest are hereby deemed voluntarily withdrawn and I or
my successor-in-interest, representatives, and assigns will no
longer participate, testify, prosecute, or provide any evidence
in said action;

6. I shall not file or cause to be filed any legal action or complaint

in connection with or arising from the incident in any office,
board, bureau, court, tribunal, and agency against Dr. Nimfa
Bautista and/or their agents, representatives, and successors-
in-interest and any and all action in connection with or arising
from the Incidnet already commenced, whether solely in my
name or jointly with others, against Dr. Nimfa Bautista and/or
their agents, representatives, and successors-in-interest are
hereby deemed voluntarily withdrawn and I or my successor-
in-interest, representatives, and assigns will no longer
 participate, testify, prosecute, or provide any evidence in said
action;

7. I shall likewise not participate, testify, provide any evidence, or

in any way assist in any and all actions or complaints in
connection with or arising from the Incident in any office,
board, bureau, court, tribunal and agency against Dr. Nimfa
Bautista and/or their agents, representatives, and successors-
in-interest;

8. I acknowledge that this Release, Waiver, and Quitclaim shall

not be construed as an admission of any wrongdoing by Dr.
Nimfa Bautista in relation to me or any other person or entity;

9. I likewise acknowledge that this Release, Waiver, and

Quitclaim shall not be construed as an admission of liability or
responsibility, nor does it indicate that I have any actionable
right against Dr. Nimfa Bautista;

10. I fully understand the statements I have made in this

document that has been explained to me in a dialect/language
I understand. I have affixed my signature hereunder
voluntarily and freely with full and complete knowledge of the
meaning and intent od this document and of my rights under
existing laws.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this _______ day of May, 2022 at Lipa City, Batangas, Philippines.

_____________________________
Affiant

BEFORE ME, a Notary Public, appeared before me and

exhibited to me her ________________ which is valid until _______,
known to me and to me known to be the same person that executed
the foregoing Release, Waiver, and Quitclaim, consisting of two (2)
pages, and acknowledged to me that the same is their free and
voluntary act and deed.

WITNESS MY HAND AND SEAL on this ____ day of May 2022,

Lipa City Batangas.

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2022