POLICY NO.

CLAIM NO.:

RELEASE OF CLAIM AND SUBROGATION RECEIPT

FOR THE SOLE CONSIDERATION THE SUM OF: THIRTEEN THOUSAND PESOS & 00/100
CENTAVOS (13,000.00) the receipt whereof is hereby acknowledge. I/We Andrew Joseph R. Banaag residing
at 72 President Quezon St., Teoville West, BF Homes, Paranaque City, do hereby release and forever
discharge PETRON CORPORATION of any and from all actions, claims, demands and rights of action
whatsoever, that now exist or may hereafter develop and particularly on account of all known, unknown and
unanticipated injuries, damages and/or losses arising out of as a consequence of an accident that occurred on
October 18, 2022 along Skyway, Magallanes Elevated,

I/We further agree that the RELEASE may be pleaded in bar to any suit, or proceedings which
I/we, or anyone in my/our behalf, may have taken or may take in connection with the accident herein before
mentioned. That this payment or service is not an admission of liability and is voluntarily accepted as a full and
final compromise adjustment and settlement of all claims and that the payment of said amounts shall never be
construed as an admission of liability by the party or parties hereby released.

I/We further agree that PETRON CORPORATION is/are subrogated to all my/our rights of
recovery on all claims, demands and rights of action on account of the loss, damage or injury as a consequence of
the accident herein before mentioned against any person/s, corporation or whosoever may be liable therefore,
that, I/we further agree to assist and hereby authorize the said PETRON CORPORATION to begin suit, prosecute,
compromise or withdraw, either in our name or in their name, all legal proceedings which they may deem
necessary to enforce my/our claim/s.

I/We manifest that the terms of this RELEASE AND SUBROGRATION RECEIPT have been read
and explained to me in a dialect, which I/we know and are thoroughly understood by me/us.

IN WITNESS WHEREOF. I/We affixed my/our signature/s below this 22nd day of February, 2023 at
Paranaque City, Philippines.

Andrew Joseph R. Banaag

AFFIANT/S

SIGNED IN THE PRESENCE OF

________________________________ ________________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF ) S.S.

Personally appeared before me this ____ day of ______________, 2023 at ______________________

the above named person/s having exhibited and submitted his/her/their valid Identification Card/s, who executed
the foregoing document and acknowledged the same to be his/her/their free act and deed and I certify that before
the execution thereof, the said document was read over and fully explained to the same person/s by me and that
he/they declared before execution that he/they fully understood the same.

NOTARY PUBLIC
Doc. No. ___________
Page No. __________
Book No. __________
Series of 2023