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, of legal age, Filipino, single/married, a resident of
_____________________________ (the Company), a corporation duly organized and existing
under Philippine Laws with principal office in Cebu City, do hereby depose and state:
1. That on

I received from the Company the amount of

pesos (Php______), as full and complete payment
of all wages and employee benefits due to me in connection with my

2. That I confirm my voluntary resignation from the Company effective

3. That I acknowledge the value of the opportunity afforded me to be of service to
the Company;
4. That I have received from the Company all of my accrued salary/wages and other
benefits, as well as all amounts that are now or in the future may be due me for
the services which I have rendered during my employment with the Company;
5. That I hereby release, remise and forever discharge the Company, its principals,
subsidiaries and affiliates, and their respective stockholders, directors, officers,
employees, representatives, or agents, from all claims, demands, cause of action,
or case of whatever nature arising from or relating to all incidents of my previous
employment with the Company or the cessation thereof;
6. That I am fully aware that I am not entitled to any other benefits, retirement pay
or otherwise, under the applicable laws or regulations, or Company policies;
7. That I shall not engage in any activity nor divulge any information, data or
documentation (whether confidential or otherwise), which I may know or possess,
that may in any way or manner, directly or indirectly, prejudice, injure or
adversely affect the business or reputation of the Company;
8. That should I violate this undertaking, I shall pay to the Company liquidated
damages equivalent to double the amount I received hereunder, without prejudice
to the Companys right to file the appropriate cases or charges and seek such
damages and losses that it may have suffered or incurred as a result of my breach
of this undertaking;
9. That I have read this document, it has been translated to me in Cebuano, and that I
have understood its contents. The entire release, waiver and quitclaim hereby
given is made by me willingly, irrevocably, unconditionally and voluntarily, and
with full knowledge of my rights under the law;
IN WITNESS WHEREOF, I have hereunto set my hand this
at Cebu City, Philippines.

day of

(Signature over Printed Name)

Signed in the presence of:

Republic of the Philippines)
City of Cebu
) S.S.
BEFORE ME, a Notary Public, on this ___th day of
, personally appeared
with SSS I.D. No.
issued on
, known to me and to me known to be that the same person
who has executed this document and who acknowledge to me that the same is his/her free and
voluntary act deed.
This instrument refers to a Release, Waiver and quitclaim consisting of two pages,
including this page, signed by
WITNESS MY HAND AND NOTARIAL SEAL on the date and at the place above
Doc No.
Page No.
Book No.
Series of 2015.