Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

National Capital Region
CAMANAVA FIELD OFFICE
5/F Araneta Square, Bonifacio Monument
Caloocan City – Tel. No. 362-3187/367-3188

_______________________________
Complainant/s, Requesting Party

-versus-

________________________________
Respondent/s.
x----- ---------------------x

QUITCLAIM AND RELEASE

(PAGTALIKOD AT PAGPAPAWALANG SAYSAY)

I, ____________________________, of legal age and residing at __________________________________________

(AKO si _____________________ nasa hustong gulang at nakatira sa _________________________________

for and in consideration of the total amount of _____________________________________________PESOS ONLY

(bilang konsiderasyon sa kabuuang halaga (Php__________________)

do hereby release and discharge _________________________________

the foresaid companies/corporations and its officer/s, person/s from any money claims by way of unpaid wages,
separation pay, overtime pay or otherwise, as may due to me in connection with past employment with
the aforementioned company/corporation, its officers/persons.
(ay aming pinawawalang saysay at tinatalikdan ang ___________________________
ang nabanggit na kumpanya/korporasyon at ang mga tauhan nito mula sa anumang paghahabol ng nauukol sa
pananalapi
sa pamamagitan ng di nababayarang sahod o anupaman na karapat-dapat para sa akin na may kaugnayan sa
aking huling
pinapasukang kumpanya o korporasyon ay sa mga opisyales o tauhan nito)

I am executing this Quitclaim and Release, freely and voluntary without any force or duress
(Isinisigaw ko ang Pagtalikod at Pagpapawalang-saysay na ito na may kalayaan at kusang loob
ng walang pamimilit o pamumuwersa)

IN WITNESS WHEREOF, I/we have hereunto set my/our hand(s) this ___th day of _________, 2018 in
the City of Caloocan, Philippines.

__________________________________________
COMPLAINANT/REQUESTING PARTY

PAID IN THE PRESENCE OF: ATTESTED BY:

____________________________ ________________________
Mgt. Representative _____________________