Quitclaim

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DEED OF RELEASE, WAIVER AND QUITCLAIM

I, _________________________, of legal age, single and residing at, _______________

__________________________, Philippines, hereby DECLARE AND MANIFEST:

That for and in consideration of the amount of ______________________ (P_____________)


paid to me by Mr./Ms.___________________________________ and receipt of which is hereby
acknowledged to my full and complete satisfaction, do hereby release and forever discharge
Mr./Ms.__________________________________________from any action, cause of action,
sum of money, liability, damages, claims and demands whatsoever by reason of the damage
sustained by his/her _________________ motor vehicle with Plate No. ______________ arising
from the accident which happened on ___________________ at _____________ involving of
said ________________________motor vehicle registered in the name of the undersigned
Mr./Ms.______________________ and the _________________ motor vehicle with Plate No.
_____________ owned by the said Mr./Ms._____________________ with the intention to
completely and absolutely waive all our right of action, causes of action, claims and demands, of
whatever nature, arising from, or in connection with the aforementioned accident.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ at


_____________, Philippines.

AFFIANT

____________________

SIGNED IN THE PRESENCE OF:

__________________ __________________

(ACKNOWLEDGEMENT)

SUBSCRIBED AND SWORN to before me, this 28th day of October 2022 by the
Affiant who whom I have identified through competent evidence of identity and who exhibited
his Driver’s License ID No. __________________ with expiration date __________________.

Doc No.________;
Page No._______;
Book No._______;

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