Release, Waiver and Quitclaim: IN WITNESS WHEREOF, I Have Hereunto Set My Hands This

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Republic of the Philippines )

Province of Biliran ) s.s.


Municipality of Naval )

RELEASE, WAIVER AND QUITCLAIM

I, _______________, of legal age, male, Filipino and a resident of


__________________, after having been duly sworn to in accordance with law, hereby
DECLARE AND MANIFEST:

That for and in consideration of the amount of _____________


(P_____________) in cash, in hand received by me to my full and complete satisfaction
as payment and/or settlement by __________________ for the repair of my Toyota
Rush with Plate No. _____________, I hereby absolutely release, completely clear, and
forever discharge the _________________________ and its driver from any action,
cause of action, sum of money, liability, damages, claims and demands whatsoever,
which in law or in equity I have, or which I, my heirs, insurer, successors and assigns
hereafter may have upon and the damage sustained by my motor vehicle arising from
the accident which happened on ___________________ at _________________
involving our said vehicles registered in the name of the undersigned and the
_________________________owned by ____________with the intention to completely
and absolutely waive all my right of action, causes of action, claims and demands, of
whatever nature, arising from, or in connection with the aforementioned accident.

I further warrant that I will institute no further action against the


______________ and/or its driver arising from, by reason of, or in connection with, the
aforementioned vehicular accident. I also manifest that the said payment/ settlement
made by the _______________________shall not be taken by me, my heirs, my
insurer or assigns, as a confession and/or admission of liability on the part of the
____________ or by his driver in connection with the aforementioned accident.

IN WITNESS WHEREOF, I have hereunto set my hands this _____________


at ____________________________________.

_____________________E
Affiant
SIGNED IN THE PRESENCE OF:

__________________ __________________

SUBSCRIBED AND SWORN to before me this _____________ at


______________________________

Doc. No. ______;


Page No. ______;
Book No. ______;
Series of ______;

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