Release, Waiver and Quitclaim
KNOW ALL MEN BY THESE PRESENTS:
That I,_____________________________________________-______________________,of legal age,
resident of ________________________________________, do by these presents hereby waive my
right as beneficiary of OWWA Death and Burial benefits and Education and Livelihood Assistance
Program (ELAP) relative to the death of my _____________, the late,
______________________________in favor of my _______________, Mr/Ms.
_________________________________. Further, I hereby quit, release discharge and waive any and all
actions of whatever nature, expected real or apparent, which I may have against the OVERSEAS
WORKERS WELFARE ADMINISTRATION (OWWA) , it’s officer, employees and agents by reason of arising
from my claim. I will institute no action, whether civil, criminal and administrative against of OWWA, its
officer employees and agents, Any and all which I maybe have commenced either solely in my name or
jointly with others before any office, board bureau, court or tribunal against OWWA officers employees
and agents are hereby deemed and considered voluntary withdrawn by me and I will no longer testify or
will testify or to continue to prosecute said action/s.
I declare that I have read this document and have fully understood its contents. I further declare that I
voluntary and willingly executed this Release, Waiver and Quitclaim with full knowledge of my rights
under the law.
IN WITNESS WHEREOF, I have hereunto set my hand this _________ day of
_______________________in___________________.
____________________________
Affiant
SUBSCRIBED AND SWORN to before me this _________________________ day of
_________________in___________________.