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Republic of the Philippines }

Tagum City }


I, ASNAIRA A. SAUMAY, of legal age, Filipino, single and a resident of

______________________, Philippines, after having been duly sworn to in
accordance with law do hereby depose and say that:

I certify that I have receivables in the amount of Php_______.00 only as salary,

separation pay and other benefits due to me under the Labor Code and other
related laws, rules and regulations. Hence, I hereby declare that I have no more
claims whatsoever against Cathy Sasing, Super C/SC Chycks. I hereby forever
set free and release her and the company from all liabilities or obligations in
relation to my services which had been completely and satisfactorily
compensated to my full satisfaction. I have voluntarily resigned from my work
effective August 22, 2017. On the other hand, the company also has no other
claims against me.

I certify that this agreement was explained to me in Cebuano, a language I

speak and understand.

Witnessed by:

_______________________ __________________________

Approved and Accepted by:

HR Executive

SUBSCRIBED AND SWORN to before me this __________________, 2017

in Tagum City, Philippines, affiant is personally known to me to be the same
person executing this agreement.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2017.