Republic of the Philippines )

City of Iloilo ) S.S.

x-----------------------------------x

AFFIDAVIT OF QUIT CLAIMS

I, _____________________________, of legal age, Filipino, single/married and a

resident ______________________________________________________, Philippines and
after having been sworn to in accordance with the law, do hereby depose and declare;

That, I am Security Guard of the _____________________________________________

with principal address at 349 Delgado-Fuentes St., Iloilo City, Philippines.

That, I have received my respective Salary / Wage in full payment in minimum wage and
remitted my Social Security System (SSS), PhilHealth Insurance, Pag-ibig Fund remittance and
Night Differential including my Overtime pay entitled thereof.

That I have no cause of actions against Licensee, President, General Manager/Manager

and Agency personnel of
____________________________________________________________.

That I was not being coerced, intimidated, or forced to signed this Affidavit of Quit
Claims for it was my voluntarily act and deed;

That, I am executing this Affidavit of Quit Claims to attest the veracity of the foregoing
facts / circumstances and the same are true and correct to the best of my knowledge and ability.

IN WITNESS WHEREOF, I have affixed my signature on this _____ day of

______________________ at Iloilo City, Philippines.

________________________
Affiant

SUBSCIRBED and SWORN to before me this _____ day of _______________ at Iloilo

City, Philippines, that I am fully convinced and satisfied that affiant having voluntarily act and
deed for legal purposes.

Doc. No. _____________

Page No. _____________
Book No. ____________
Series No. ____________