I, ____, Filipino, of age, (single/married/widowed) and resident of _____, Philippines, after taking the oath in accordance with the law, file and declare: 4. I further agree that this WAIVER, INDEMNIFICATION AND TERMINATION may be invoked with respect to any action or proceeding (civil law, SSS, PhilHealth, Medicare, Labor, etc.) involving either myself or my heirs and assigns, may have violated my employer in the course of my employment with my employer, and that the payment, which I have received as provided herein, shall in no way be construed as an admission of liability on the part of my employer and is voluntarily accepted by me and, if applicable, serves as full and final settlement of all amounts due to me or any claim or cause of action, past, present, future that I may have in the course of my employment with my employer; 3. That I hereby declare that I have no further claims against my employer, its president, directors, officers or any of its employees and that I indemnify and hold harmless all claims, demands and causes of action of any kind arising out of my employment with the employer; IN WITNESS WHEREOF, I hereby have control over ___ 5.As declare that I have no further claim or cause of action against my employer or against any person connected with the administration and operation of my employer, and forever release him from any liability. 1. That I declare by these gifts that I have voluntarily resigned as __Position Held__ of __Employer__; That for and in consideration of the amount of ___P______________ cause of action, money, liability, damages, claims and demands of every kind that I/we have at law or in equity, or that I/we, our heirs, insurers, successors and assigns are entitled as a result of injuries sustained by me / us and damages to our ___ ____ Republic of the Philippines) Province ____) S.S. City/Municipality ___) x – – – x. I/We further warrant that I/We will not take any further action against such _____ and/or its driver ____ I/We also declare that such payment/settlement by such ____ shall not be construed by us, our heirs, our insurer or assignee as a confession and/or admission of liability by said ____ or its driver ___ in connection with the above accident. 2. That I hereby confirm from my employer the amount of ____P______________.
