Authorization and Waiver

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WAIVER, RELEASE OF LIABILITY AND INDEMNITY

AGREEMENT

Know All Men By These Presents:

We, ____________________, and _____________, both of legal age, married, and with
residence at ____________________________, and ________________________,
respectively, after having been duly sworn to in accordance with law, hereby depose and state
that:

1. This to authorize ____________________, to


___________________________________________, under the Contract of Lease dated
_______________.

2. In connection with the security deposit, we hereby RELEASE, WAIVE, FOREVER


DISCHARGE and AGREE TO HOLD HARMLESS ____________________, its subsidiaries, as
well as its Stockholders, Directors, Officers and Staff and any and all parties with interest
therein, whether named or unnamed, from any and all actions, suits, debts, dues, sums of
money account, claims, demands and/or rights of action whatsoever, granted by law, contract,
collective bargaining agreement, tort or equity, arising out of, by reason of, or in connection
with the refund of the security deposit.

5. We agree and undertake to protect, defend and indemnify (including legal costs and
expenses) ____________________, as well as its Stockholders, Directors, Officers and Staff and
any and all parties with interest therein, whether named or unnamed, against any claims,
demands, or cause of action, whatsoever by any person whosoever against any party from any
claim or damages arising out of or by reason of the security deposit released to us under the
account of ____________________.

6. We also certify that we fully understand the contents, effects and consequences of
executing this affidavit to our full understanding and satisfaction.

7. Finally, we hereby state and affirm that we executed this statement voluntarily,
intelligently and out of our own free will.

IN WITNESS WHEREOF, we have hereunto set our hand this _____ day of
____________ 2014 in Quezon City.

________________
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of _________, 2014, in


Quezon City, personally appeared the above mentioned persons with her Driver’s
License/SSS/Passport No. _________ issued on _____________.

Notary Public
Doc. No. ____
Book No. ____
Page No. ____
Series of 2014.

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