RELEASE WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, ________, of legal age, Filipino and with address at _________________, do hereby
state under oath, that:

I acknowledge that I have received from Rosarette V. Martinez the amount of
____________ Thousand Pesos (__________) as financial assistance. I further declare that
Rosarette V. Martinez has no obligation to me whatsoever arising from an employer-employee
relationship such as salaries and other benefits, SSS or other government-mandated
contributions, privileges, monetary or otherwise.

I hereby release and forever discharge Rosarette V. Martinez, her heirs, employees,
representatives, officers and agents from any and all manner of claims, causes of action, sum of
money, damages, claims and demand, whatsoever in law or in equity which my heirs, successors
and assigns had, now have or shall have against Rosarette V. Martinez.

I hereby declare that the payment by Rosarette V. Martinez of the foregoing
consideration shall not to be taken by me, my heirs or assigns as a confession and/or admission
of liability on the part of Rosarette V. Martinez, for any matter, cause, demand or damages that I
may have against her.

I finally declare that I have read this document and the Release Waiver and Quitclaim
hereby given is made willingly and voluntarily and with full knowledge and understanding of my
rights under the law.

IN WITNESS WHEREOF, I have hereunto set my hands this ___ day of _____________
at Bacolod City.



__________________________



SIGNED IN THE PRESENCE OF:




____________________________ ____________________________






ACKNOWLEDGMENT


REPUBLIC OF THE PHILIPPINES)
BACOLOD CITY ) S.S.

BEFORE ME, a Notary Public for and in Bacolod City this ___ day of _________,
personally appeared _______________ with Comm. Tax Cert. No. ____________ issued on
________ at _________ known to me and by me known to be the same person who executed the
foregoing Release Waiver and Quitclaim and he acknowledged to me that the same is his free
and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and at the place first abovewritten.


Doc. No. _____;
Page No._____;
Book No._____;
Series of 2011.