Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. 02Tuguegarao City,
Cagayan ________________________ Complainant/s CASE NO. ______________________
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V
ersus - ________________________ Respondent/s
QUITCLAIM AND RELEASECOMES NOW
the undersigned complainant in the above entitled case before thisOffice, respectfully manifest:That for in consideration of the
sum of ________________________________________ (P ____________) in settlement of my / our claim; as financial
assistance and / or gratuitouslygiven by my / our employer, receipt of which is hereby acknowledge to my / our complete andfull
satisfaction. I / we hereby release and discharge the _______________________ and / or itsofficer, from any and all by way of
unpaid wages, separation pay, overtime pay, differential payor otherwise as may be due me/us incident to my/our past
employment with said establishment.I/We hereby state further that I/We have no more claim or cause of action of whatever
naturewhether past, present or contingent against the said ____________________ and/or its officer.In view hereof, I/We hereby
move for dismissal of the above entitle case and further request that the same dropped from the business calendar of this office.IN
WITNESS WHEREOF, I/We hereunto set my/our hand/s this _________day of ____________ at
_____________. ________________________ Complainant/sPAID IN THE PRESENCE
OF: ______________________________ __________________________ SUBSCRIBED AND SWORN to before me this
______________, day of ______________ at _________________