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Form No. 1--Waiver Release and Quitclaim
(Waiver Release
and Quitclaim)
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
Held__ of __Employer__;
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
(JURAT)
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