RELEASE WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

That I,_____________________, Filipino, of legal age, a resident of

_____________________, as the Project Engineer engaged by the La Cosa Nostra
Landholdings Inc. herein referred to as the “Project Owner” in the construction of a three- storey
Building located at Caggay Tuguegarao City herein referred to as ( “the Project”) , do hereby
acknowledge receipt of the sum of _____________________________________
_(Php ), Philippine Currency, in __________Bank Check
No.____________________, dated ___________________, from LA COSA NOSTRA
LANDHOLDINGS INC., representing full payment of all enumeration and benefits due me
including any and all claims of whatever kind and nature which I have or may have against the
Project Owner, or under any existing agreement with respect thereto.

In consideration of said payment, I do hereby quitclaim, release, discharge and waive

any and all actions of whatever nature, expected, real or apparent, which I may have against
LA COSA NOSTRA LANDHOLDINGS INC., its directors, officers, employees, agents and
representatives by reason of or arising from my former engagement with LA COSA NOSTRA
LANDHOLDINGS INC..

I will institute no action, whether civil, criminal, labor or administrative against LA COSA
NOSTRA LANDHOLDINGS INC., its directors, officers, employees, agents and representatives.
Any and all actions which I may have commenced either solely in my name or jointly with others
before any office, board, bureau, court, or tribunal against LA COSA NOSTRA
LANDHOLDINGS INC., its directors, officers, employees, agents and clients are hereby deemed
and considered voluntary withdrawn by me and I will no longer testify or continue to prosecute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 voluntarily 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 at

___________________________, this ________________, 2017.

_______________________
Signature over Printed Name

SIGNED IN THE PRESENCE OF:

_________________________ _________________________

Republic of the Philippines)

________________________) S.S.

SUBSCRIBED AND SWORN TO before me this _________________ 2017 at __________________,

affiant exhibiting to me his ID No. _________________ issued at __________________ on
_____________________.

Doc No. ______;

Page No. ______;
Book No. ______;
Series of 2017.