WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, MARIE CLAIRE YADAO, 14 years old, single, Filipino and with residence and
postal address at San Isidro, Buguey, Cagayan hereby depose and state:
That I was injured by a motorcycle driven by MIKA T. SEBASTIAN, last July 10,
2016 at around 11:00AM oclock in the morning in San Isidro, Buguey, Cagayan;
That considering that MIKA T. SEBASTIAN had already paid my medical
expenses and had already paid me the amount of ONE THOUSAND FIVE HUNDRED
(PHP1,500.00) in connection with my treatment in the hospital, I hereby WAIVE,
FOREGO and QUITCLAIM all my rights to file any case, criminal as well as civil against
MARIE CLAIRE YADAO and by virtue hereof, hereby release her of any liability
whatsoever because of the incident.
That I am executing this waiver and quitclaim out of my own volition and free will
without being force or intimidated to execute and signed this document.
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of July
2016 at Buguey, Cagayan.
MARIE CLAIRE YADAO
Assisted by:
ELISA L. YADAO
Mother
SIGNED IN THE PRESENCE OF:
_____________________
Witness

_____________________
Witness

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAGAYAN ) S.S.
MUNICIPALITY OF BUGUEY
)
BEFORE ME, a Notary Public, personally came and appeared the above named
persons with their barangay clearances known to me and to me known to be the same
persons who executed the foregoing instrument and acknowledged to me that the same
is their own free voluntary acts and deeds.
WITNESS MY HAND AND SEAL, this 17th day of July 2016 at Buguey,
Cagayan.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2016.

ERNANI T. TADILI
NOTARY PUBLIC
Until December 31, 2016
IBP OR No. 946905
PTR OR No. 6485838
Attorneys Roll No. 64233
MCLE Compliance No. V-0013985