DOLE SENA Form No.

5 Republic of the Philippines Date Filed:

Quitclaim & Release Department of Labor and Employment
National Capital Region DECEMBER 28, 2018
CAMANAVA FIELD OFFICE

SINGLE –ENTRY APPROACH (SENA)

(Per Department Order No. 107, Series of 2010, dated 5 October 2010)

IN THE MATTER OF REQUEST FOR ASSISTANCE OF:n

Requesting Party/ies: JOHN CARLO M. HERRERA SEAD-NCR-CFO-WALK-IN SETTLEMENT

Responding Party/ies: VALIANT PAPER ASIA PACIFIC CORPORATION

QUITCLAIM AND RELEASE

(PAGTALIKOD AT PAGPAPAWALANG SAYSAY)

I, JOHN CARLO M. HERRERA , of legal age and residing at BAGBAGUIN, VALENZUELA CITY
(AKO si,__________________________, nasa hustong gulang at nakatira sa__________________________________.)

for and in consideration of the total amount of TWENTY ONE THOUSAND FOUR HUNDRED NINTY THREE PESOS & 50/100
(P21,493.50)
(bilang konsiderasyon sa kabuuang halagang ______________________________________________________________

do hereby release and discharge VALIANT PAPER ASIA PACIFIC CORPORATION the aforesaid
companies/corporations/person and its officer/s, person/s from any money claims by way of underpaid wages, separation pay/retirement
pay, overtime pay or otherwise, as may due to me in connection with my past employment with the aforementioned
company/corporation/person, its officers/persons.(ay aking/aming pinawawalang saysay at tinatalikdan
ang/si__________________________________________ang nabanggit na kumpanya/korporasyon/tao at ang mga tauhan nito
mula sa anumang paghahabol ng nauukol sa pananalapisa pamamagitan ng di nababayarang sahod o anupaman na karapat-dapat
para sa akin na may kaugnayan sa aking pagtatrabaho sa kumpanya o korporasyon o sa mga opisyales o tauhan nito)

I am executing this Quitclaim and Release, freely and voluntary before this Office without any force or duress
(Isinisigaw ko ang Pagtalikod at Pagpapawalang-saysay na ito na may kalayaan at kusang loob sa harapan ng
tanggapang ito ng walang pamimilit o pamumuwersa)

and as part of the settlement agreement reached during the conciliating-mediation process conducted in the
DOLE- CAMANAVA FIELD OFFICE.
(at bilang bahagi ng napagkasunduan buhat sa proseso ng conciliation-mediation dito sa (DOLE- CAMANAVA FO)

IN VIEW WHEREOF, WE hereto set my hand this 14th day of December 2018 at DOLE-CAMANAVAField Office Caloocan City.
(DAHIL DITO, Kami ay lumagda ngayong araw ng _________________ sa DOLE-CAMANAVA Field Office, Caloocan City.)

__________________________
Signature of Requesting Party/ies
(Lagda ng PartidongHumiling)

Signed in the Presence of (Nilagdaan sa Harapan ni):

___________________________________
ANNALISA MENDOZA
HR Manager, Valiant Paper Asia Pacific Corporation

WITNESSED this 28th day of December 2018 at Caloocan City, Philippines.

_______________________
GERRY P. MALGAPO
LEO III
SEnA Officer

NOTED:

_______________________________
ROWELLA V. GRANDE
Director, CAMANAVA Field Office