Quitclaim

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Republic of the Philippines )

Ormoc City. )S.S.

WAIVER, RELEASE AND QUITCLAIM

I, _______________________________, Filipino, of legal age, single, and a resident of


Isla Verde, Brgy. West, Ormoc City, Philippines, after being sworn to in accordance with law,
depose and state: that

1. I have voluntarily severed my ties with Pinky Cafe.

2. I hereby acknowledge to have received from the abovementioned company the sum of
____________________________________ (Php_______) which is in full and final
satisfaction of my salary and other benefits that may be due me for the services which I
have rendered to the company;

3. I hereby declare that I have no further claims whatsoever against Pinky Cafe and it’s
owner, Ma. Thea Gubalane, and that I hereby release and forever discharge her from any
and all claims, demands, cause of action of whatever nature arising out of my
employment with ;

4. I further agree that this WAIVER, RELEASE AND QUITCLAIM may be pleaded in bar to any
suit or proceeding (Civil, SSS, PhilHealth, PagIbig, Labor, etc.) to which either I, or my
heirs and assigns, may have against my employers in connection with my employment in
the company and that the payment which I have received as provided herein should not
in any way be construed as an admission of liability and is voluntarily accepted by me
and will serve as full and final settlement of any amounts due me or any claims or cause
of action, either past, present, future, which I may have in connection with my
employment with them;

5. As such, I have no further claim(s) or cause of action against Pinky Cafe nor against it’s
owner Ma. Thea Gubalane and in connection with the administration and operation of
the said company and forever release the latter from any and all liability;

6. I finally declare that I have read this entire document, the contents of which have been
explained to me and which I acknowledge to understand; and the entire release, waiver,
and quitclaim hereby given are made by me willingly, voluntarily and with full
knowledge of my rights under the law.

IN WITNESS WHEREOF, I have hereunto set my signature, this __ day of ______, 2024 at
Real Street, Brgy. West, Ormoc City, Philippines.

___________________________
Affiant

Signed in the presence of:

___________________________ _______________________________
WITNESS WITNESS

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