NLRC Quitclaim Release

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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF LABOR AND EMPLOYMENT


NATIONAL LABOR RELATIONS COMMISSION
NATIONAL CAPITAL REGION
QUEZON CITY

_________________________________
Complainant,

-versus- NLRC-NCR Case No. ________________

_________________________________
Respondent.

x----------------------x

QUITCLAIM AND RELEASE


I, _________________________of legal age, with address at _______________________,
after having been duly sworn to an oath in accordance with law, depose and say:

1. I was an employee of ______________________________, with address at


_______________________________________________________________.

2. On the _____ day of ________________, I filed the instant case for illegal dismissal as
well as for the payment of underpaid benefits;

3. That after much thought, I now realize my mistake in filing the instant case. I declare
that I resigned from my work voluntary and of my own free will and design. Being so, I
have no cause of action against my said employer nor any of its officers,
representatives, successors or assigns;

4. I likewise declare that I am not entitled to any underpayment as I mentioned in this


complaint, and hereby free the respondents in this case from any liability whatsoever
from any issues arising from the subject complaint, including that which pertains to the
Social Security Service (SSS), Pag-ibig, and Philhealth.

5. Should there exist anything in the future that may entitle me to file any action against my
employer for any cause of action whatsoever, I hereby waive by these presents
whatever rights that I may have, to institute or maintain the same;

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of


___________________ at ____________________________.

_______________________________
COMPLAINANT

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ at


_____________________ by the complainant ___________________________. I hereby
certify that I have personally examined the complainant and I am satisfied that he voluntarily
executed and understood the said Quitclaim and Release.

WITNESS MY HAND AND SEAL this _____ day of _______________, 20____ at


_____________________.

_______________________________
LABOR ARBITER

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