The undersingned have agreed and receivefd from CHINA AIRLINES LTD., the sum of__________Dollars.
In considertion of the receipt of the above-named amount, I hereby release and discharge CHINA AIRLINES LTD., its associated companies, agents, officers, employees and others from any and all claims and demands which I now have or may hereafter have on account of___________________________which occurred on or about the__________day of___________20_____________Signed at____________________________________________________________________________________
( City) (State) (Country)
this____________________day of________________20____________________
______________________________
(Signature)
Address:_______________________
WITNESSED BY
Name:_________________________
Address:________________________