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Release, Waiver and Quitclaim

The document is a release, waiver and quitclaim signed by a guardian acknowledging receipt of payment from a driver for damages suffered in an accident involving the driver's vehicle colliding with the guardian's child on a bicycle. The guardian agrees to waive and withdraw any civil or criminal actions against the driver in consideration of payment and medical expenses covered by the driver. The guardian declares understanding of the document and voluntary execution of the release.

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86 views2 pages

Release, Waiver and Quitclaim

The document is a release, waiver and quitclaim signed by a guardian acknowledging receipt of payment from a driver for damages suffered in an accident involving the driver's vehicle colliding with the guardian's child on a bicycle. The guardian agrees to waive and withdraw any civil or criminal actions against the driver in consideration of payment and medical expenses covered by the driver. The guardian declares understanding of the document and voluntary execution of the release.

Uploaded by

ciryajam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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RELEASE, WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:


That
I,
________________,
the
guardian
of
________________________
and
a
resident
of
______________________________, Filipino citizen, do by these presents
acknowledge receipt of the sum of ________________________
(________________.00),
Philippine
Currency,
from
Sister
_________________________, driver of _________________, with
plate number _________________, in full payment and final settlement of all
the damages I suffered during an accident on ___________________
involving the said vehicle, colliding with a bicycle driven by my child
_________________, a minor, somewhere in ____________________,
which is due to me or which may be due to me resulting from the said accident.
In consideration of said payment and the fact that all our medical and
related expenses were shouldered by Sister ______________________, I do
hereby quitclaim, release, discharge and waive any and all actions of
whatever nature, expected, real or apparent, which I may have against Sister
_____________________________. I will institute no action, whether
civil or criminal, against said Sister ______________________. Any and all
actions which I may have commenced, before any office, board, bureau, court, or
tribunal against Sister _________________________, are hereby deemed
and considered voluntarily withdrawn by me and I will no longer testify or
continue to prosecute said action(s).
I declare that I have read this document, that this document has been fully
explained to me, and that I have fully understood its contents. I further declare
that I voluntarily and willingly execute this Release, Waiver and Quitclaim with
full knowledge of my rights under the law.
IN WITNESS WHEREOF, I have hereunto set my hand at
__________________, ________________, this _____ day of October,
2016.

For and in behalf of


___________________:
minor
___________________:
guardian
SIGNED IN THE PRESENCE OF:

________________________

__________________________

ACKNOWLEDGMENT
Republic of the Philippines )
____________________)s.s.
____________________)
Before me, a notary public, this ____ day of October, 2016, personally
appeared ____________________, exhibiting her Identification Document,
through which I am convinced that she is the same person who executed the
foregoing Release/Waiver and Quit Claim which she acknowledged to me that the
same is her free and voluntary act and deed.
This document consists of two (2) pages including this page on which
Acknowledgment
is
written
and
has
been
signed
by
_____________________ and her witnesses on each and every page.

Doc. No. ______


Page No.______
Book No.______
Series of 2016.

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