Philhealth Waiver

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Republic of the Philippines

City/Municipality of Manila
x--------------x
WAIVER
I, _____________, Filipino, of legal age, (single / married / widow), and a
resident of _____________, Philippines, depose and state:

1. That by these presents, I hereby state that I am a child of the deceased


Maria Dolores Banzon Beltran, owner of Miguis Caf, .
2. That I hereby acknowledge that my sister Maria Isabel Banzon Beltran has
taken the former employees of Miguis Caf under her to work for her new
business Miguis Fast Food.
3. That I hereby declare that I have no further claims whatsoever against
the business, its owner or any of its staff and that I hereby release and
forever discharge all of them from any and all claims, demands, cause of
action of whatever nature arising out of my claim to Miguis Cafe;

4. I further agree that this WAIVER may be pleaded in bar to any suit or
proceeding (Civil, SSS, PhilHealth, Medicare, Labor, etc.) to which either I, or
my heirs and assigns, may have against my sister, Maria Isabel Banzon
Beltran, in connection with my claim to the business of our mother.

5.As such, I finally make manifest that I have no further claim(s) or cause of
action against Miguis Cafe nor against any person(s) connected with the

administration and operation of the latter and forever release the latter from
any and all liability.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________
at _____________, Philippines.
Affiant

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