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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 (Sgd.)

(JURAT)
REPUBLIC OF THE PHILIPPINES)
City of Iloilo ) S.S.
x-------------------------------------------------------x

AFFIDAVIT OF LOSS

I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after


having been sworn in accordance with law hereby depose and state:

1. That I am the true and lawful owner of a certain motor vehicle which is more
particularly described as follows:

MAKE : MOTOR NO. :


SERIES : SERIAL/CHASSIS NO. :
TYPE OF BODY : PLATE NO. :
YEAR MODEL : FILE NO. :

2. That sometime in June of this year, I was looking for the original Certificate of
Registration of my car but to my surprise, said Owner’s original Copy could not
found;

3. That I took pains to look for said Certificate of Registration, but to no avail;

4. That I am executing this affidavit to attest to the truth of the foregoing and to
request from the Land Transportation Office of Angeles City, a copy of said
Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of


_______________. 20___ at ________________________

(Name Over Signature of Affiant)

SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in
___________________ City, with affiant exhibiting his CTC No. _______________ ,

Issued on ______________________ at _________________________.

NOTARY PUBLIC

Until December 31, 200___


Republic of the Philippines )
____________,_____________ ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

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


resident of
________________________________________________ , after having been sworn in
accordance with law, hereby deposes and states the following:

1. I am holder/owner/ or possessor of the following identification card / document:


2. I have recently discovered the said item/s is/are irretrievably lost and can no longer
be found despite diligent efforts to locate the same;
3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

Affiant
(Signature over Printed Name)

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The
affiant exhibited to me his competent evidence of identity as indicated above.

Signed this ______________at ________________, ______________________, Philippines.

WITNESS MY HAND AND SEAL.

Notary Public
AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)


CITY OF MANILA ) S.S.

I, Juan del la Cruz, of legal age, single, and a resident of # 123 Main St., Malate,
Manila, after having duly sworn to in accordance with law hereby depose and state:

1. I am the complaining witness for Serious Physical Injuries against Jesus Santos in
the case entitled "People of the Philippines versus Jesus Santos", Criminal Case No.
12345, Metropolitan Trial Court, Branch No. 11, City of Manila.
2. After my sober and soul searching assessment and analysis of the incident, I have
realized that because I was not wearing my eyeglasses and it was dark, I cannot
point out, without a doubt the accused or any other person/s who inflicted harm
against me.
3. Since I could not state with certainty and without doubt the liability of Jesus Santos,
in fairness to him, I am permanently withdrawing my complaint against him. I clear
him of whatever responsibility or liability to me.
4. I hereby inform the City Prosecutor of Manila that I am withdrawing my complaint
for Serious Physical Injuries in Criminal Case No. 12345 entitled "People of the
Philippines versus Jesus Santos", Metropolitan Trial Court, Branch No. 11, City of
Manila.
5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of Manila to
dismiss with prejudice the said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this __ day of September 20__ at the
City of Manila.

Juan de la Cruz
Complaining Witness

SUBSCRIBED AND SWORN to before me this 22nd day of January 20__ at the City of
Manila, Philippines.

Romeo Abad
Public Prosecutor