REPUBLIC OF THE PHILIPPINES )
CITY OF __________________ ) S.S.
RELEASE, WAIVER AND QUITCLAIM,
WITH UNDERTAKING
I, ____________________, ____ years of age, Filipino, single/married, with
residence and postal address at ____________________________, after having duly
sworn to in accordance with the law, depose and state: That -1. I have a claim for payment of deposit in the total amount of P
__________________ against the assets of Unitrust Development Bank
(UDB), a closed bank under liquidation by the Philippine Deposit
Insurance Corporation (PDIC);
2. In line with the Order dated March 19, 2007 by the Regional Trial Court
of Makati City, Branch 59 (the Liquidation Court of UDB) issued in SP.
PROC. No. M-6069 entitled “In re: Petition for Assistance in the
Liquidation of the Unitrust Development Bank,” authorizing/approving
the payment of my deposit claim, I hereby acknowledge receipt from
UDB, thru its Liquidator PDIC, the partial payments of my deposit claim
in check as follows:
P ____________ representing 44.4725% of my outstanding
claim paid to me on __________________ and P
______________ representing 62% of my remaining claim of
55.5725%, or the total paid amount of P______________ out of
my
total
outstanding
deposit
claim
of
P_____________________;
3. To my complete and full satisfaction, I hereby RELEASE AND DISCHARGE
UDB, to the extent of the amount of P_________________. Likewise, I
hereby release PDIC, its officers, employees, agents or representatives,
from any and all liabilities whatsoever emanating, directly or indirectly,
from the claim as partially paid; And for this purpose, I hereby hold
PDIC and its officers, employees, agents or representatives, legally free
and harmless from any and all liabilities or claims arising thereto;
4. Should UDB, or PDIC and/ or the latter’s officers, employees, agents or
representatives be held liable/accountable for whatever reason as a
result of such payment, I hereby agree and undertake to fully assume
the same, and shall indemnify, to the extent of the amount of
P_______________, UDB, or PDIC and/or the latter’s officers, employees,
agents or representatives either by refunding the same upon demand,
or indemnifying UDB or PDIC for whatever losses or damages that may
arise by reason of the foregoing payment to the extent of the amount
partially paid to me by UDB, thru its Liquidator PDIC;
5. Finally, I hereby declare that I have fully read and understood the
contents of this document and that this Release, Waiver and Quitclaim,
with Undertaking is made freely and voluntarily, with full knowledge of
my rights under the law.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ______
2013 in ________________, Philippines.
_____________________
Claimant
SUBSCRIBED AND SWORN TO before me this ___ day of ____________, 2013.
The Claimant exhibited to me his/her Identification Card No. _________ issued on
____________ at ______________.
Notary Public
Doc. No. ___:
Page No. ___:
Book No. ___:
Series of 2013.