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Sample Release and Waiver

Release of Claim Waiver


Republic of the Philippines )
City of Makati                ) S.S.
x--------------------------x


RELEASE AND WAIVER


            IBRAD PETE, of legal age, Filipino citizen, and presently residing at 123 J. Victor Street, Pio Del Pilar, Makati City, after having been duly sworn to in accordance with law, do hereby depose and say:

1.  That as a result of a motor vehicle accident which occurred on November 1, 2013 in Quezon City, when I was hit by a car driven by Jenna Niston and owned by Katy Homs, I filed a criminal and civil complaint against both Jenna Niston and Katy Homs in the Regional Trial Court of Makati City.

2.  That after verifying the facts, I realized that said Jenna Niston was not altogether reckless in driving said vehicle;

3.  That in order to settle the case amicably and since the owner of the car Katy Homs had offered to pay the sum of P20,000 for all the medical expenses and the losses that I sustained, which I hereby acknowledge, I am withdrawing my complaint in both civil and criminal cases filed in the Regional Trial Court of Makati City (Civil Case No. 123 and Criminal Case no. 3456);

4.  That by virtue thereof, I hereby waive any and all claims, criminal or civil, against said persons, and further release and discharge them from any and all liability.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of January 2014 at Makati City, Philippines.


                                                                                            BRAD PETE
                                                                                                Affiant
                                                                                   

            SUBSCRIBED AND SWORN to before me this 6th day of January 2014 in Makati City, Philippines, affiant exhibiting to me his competent evidence of identity by way of SSS I.D. No. 12345 issued at Makati City on May 5, 2012.

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Book No.: ______                                              
Series of 2014                                                                Notary Public                             

 

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