Affidavit of Quitclaim Release (Blank)

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REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF QUITCLAIM/RELEASE

I, ______________ Filipino, of legal age, single/married, and with residence address at


____________________________________, after having been sworn in accordance with law, do hereby
depose and state that:

1. I have voluntarily and unconditionally resigned from ________________. effective _______________;

2. I hereby acknowledge receipt of the sum in cash of ________________________________________


(P __________). With my receipt of such amount, I hereby affirm, manifest and voluntarily declare that
during the entire period of my employment with _____________________, I was paid and received in
full all compensations, wages, salaries, commissions, bonuses, 13th-month pay, benefits and
privileges due me or which I am entitled to under existing laws by reason of such employment, and the
receipt thereof constitutes full and complete payment of and settlement for any and all claims of
whatever kind and nature which I have or may have against said company, its officers, agents or
assignees, thereby releasing ________________ its agents, officers, and assignees from any and all
liabilities and obligations towards me;

3. Furthermore, I manifest and voluntarily declare that I have no cause of action or claim whatsoever
against _________________ its officers, agents, or assignees. As a consequence thereof, I shall
desist from filing any complaint, civil, criminal or administrative, against ____________________ its
officers, agents, or assignees in, including but not limited to, all government/administrative agencies,
departments, offices, quasi-judicial agencies, the courts and tribunals of the Republic of the
Philippines.

4. I further manifest that during the entire period of my employment with ___________________ I have
never met any disabling accident, arising out of or in the course of my duties thereat nor have I
become sick or disabled because of such employment;

5. I declare finally that I have read the contents hereof fully and I completely understand the same and/or
that the contents hereof have been fully read and explained in a language or dialect known to me
before signing the same and this Affidavit of Quitclaim/Release is made voluntarily and willingly with
full knowledge of my rights and privileges under the law;

6. I have executed the foregoing affidavit to attest to the truth of the facts hereinstated.

AFFIANT FURTHER SAYETH NAUGHT.

__________________
AFFIANT

WITNESSED BY:

_________________________ _________________________

SUBSCRIBED AND SWORN to before me this ______ day of _____________ 200__, affiant exhibiting to
me her/his C.T.C. No. ______________ issued on ___________________ at ____________________.

Doc. No. ______


Page No. ______
Book No. ______
Series of 2020 ___

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