Financial Waiver Document

FINANCIAL WAIVER DOCUMENT

Parties and Identifiers

Recitals

This Financial Waiver Document (the "Waiver") is entered into by and between Creditor: and Debtor: .

WHEREAS, Debtor has an outstanding obligation identified by Account / Reference Number: ; and

WHEREAS, Creditor is willing to waive certain charges under the terms set forth herein without admission of liability; and

NOW, THEREFORE, in consideration of the mutual covenants and other good and valuable consideration, receipt of which is hereby acknowledged, the parties agree as follows.

Waiver Terms

1. Waiver Amount: Creditor agrees to waive the sum of $ (the "Waived Amount"). The original obligation reflected was $ . Remaining balance, if any, is $ .

2. Scope of Waiver: The Waived Amount pertains strictly to the charges identified in the Account / Reference number above and applies only to obligations that arose on or before the Effective Date of this Waiver. This Waiver does not apply to any obligations not expressly described herein.

3. Effective Date: This Waiver is effective as of , .

4. Consideration: Debtor acknowledges receipt of consideration for the Waiver consisting of the Creditor's forbearance and the mutual promises contained herein. This consideration is adequate and binding.

5. Release and Covenant Not to Sue: Upon execution of this Waiver, Debtor is released from liability to the extent of the Waived Amount, and Debtor covenants not to institute suit or bring any claim against Creditor for recovery of the Waived Amount. This Release is intended to be final and binding.

6. No Admission of Liability: The parties agree that this Waiver constitutes a compromise of disputed claims and shall not be construed as an admission of wrongdoing or liability by any party.

7. Representations and Authority: Each party represents and warrants that it has full authority to enter into this Waiver and that the undersigned authorized representative has been duly empowered to bind the respective party.

8. Tax and Reporting Obligations: Each party is responsible for its own tax and reporting obligations arising from this Waiver. Creditor will report any cancellation of debt or forgiveness as required by applicable law, and Debtor shall cooperate with any reporting exigencies.

9. Indemnity: Debtor shall indemnify, defend and hold Creditor harmless from any claims, penalties, or liabilities attributable to Debtor's failure to pay any taxes or to report the Waived Amount where required by law.

10. Remedies; Defaults: If Debtor makes any false representation material to this Waiver, Creditor may, at its election, rescind this Waiver and proceed to enforce the original obligation in full. Creditor's election to enforce does not preclude any other remedy available at law or equity.

11. Governing Law: This Waiver shall be governed by and construed in accordance with the laws of the jurisdiction agreed by the parties. The parties submit to the exclusive jurisdiction of that jurisdiction's courts for resolution of any disputes arising hereunder.

12. Severability and Entire Agreement: If any provision of this Waiver is held invalid or unenforceable, the remaining provisions will continue in full force. This Waiver constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior negotiations and agreements on this subject.

Payment and Administrative Details

If a Remaining Balance is reflected above, payment shall be made in accordance with the following schedule:

Acknowledgement

By executing below, each signatory represents that the signatory has read and understands this Waiver, that the signatory is authorized to enter into this Waiver on behalf of the party for which the signatory signs, and that the signatory accepts the terms and conditions set forth herein.

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