RELEASE AND WAIVER (REQUEST FOR TEMPORARY POWER INTERRUPTION

RTPI/ RESTORATION)

Our company, _______________________________ with principal office at __________________________________________________ represented by ____________________________do hereby waive any and all rights of action, claims or demands for any loss of life, physical injury or damage to property that may be suffered by our company, employees or agents, arising from the action taken by the Manila Electric Company (MERALCO) upon our request for temporary power interruption or arising from the restoration of power. Furthermore, our company agrees to hold MERALCO, its offices, employees or agents free and harmless from any cause of action or claims for damages of third parties arising from, or incidental to the power interruption and/or restoration of power to the aforesaid property or premises of our company on ______________, 200__. Moreover, in the event that MERALCO’s personnel and/or its contractors are injured or its equipment damaged as a result of the temporary power interruption and/or restoration of power, all costs and expenses attendant thereto shall be borne by our company. PROVIDED HOWEVER, that this waiver executed by our company in favor of MERALCO cannot be availed of by the latter by way of special defense in any judicial proceedings that may arise in connection therewith when such damage or injury caused to our personnel and property including third parties was the direct result of MERALCO’s fault or gross negligence. Signed at ______________________ this ______ day of _______, 200__.

______________________________ Name of Corporation, Partnership, or

Single Proprietorship

By:___________________________ Full Name and Position Title

Service ID No.________________ Account Name:________________ Date & Time of Interruption: __________________ Date & Time of Restoration: __________________ Contact Person at site: ______________________ Contact Numbers: __________________________ Reason for interruption: ______________________