MoneyGram 2011 Annual Report Download - page 239

Exhibit A
RELEASE
This RELEASE (“Release”) is dated as of between MoneyGram International, Inc., a Delaware corporation (together with its parent
companies, direct and indirect subsidiaries, successors and assigns, the “Company”), and [ ] (“Executive”).
WHEREAS, the Company and Executive previously entered into a Severance Agreement dated [ ], 20[ ] (the “Severance Agreement”); and
WHEREAS, Executive’s employment with the Company (has been) (will be) terminated effective ; and
WHEREAS, pursuant to the Severance Agreement, Executive is entitled to certain compensation and benefits upon such termination, contingent upon
the execution of this Release;
NOW, THEREFORE, in consideration of the premises and mutual agreements contained herein and in the Severance Agreement, to which Executive
understands and acknowledges he or she may not otherwise be entitled without executing this Release, the Company and Executive agree as follows:
1. Executive, on his or her own behalf and on behalf of his or her heirs, estate and beneficiaries, hereby releases and forever discharges the Company,
its parent companies, predecessors, successors, affiliates, subsidiaries, related companies, shareholders, and their respective members, managers, partners,
employees, officers, agents, and directors (individually a “Released Party” and collectively the “Released Parties”) from the following:
a. All claims arising out of or relating to Executive’s employment with the Company and/or Executive’s separation from that employment.
b. All claims arising out of or relating to the statements, actions, or omissions of the Released Parties.
c. All claims for any alleged unlawful discrimination, harassment, retaliation or reprisal, or other alleged unlawful practices arising under any
federal, state, or local statute, ordinance, or regulation, including without limitation, claims under Title VII of the Civil Rights Act of 1964, as
amended; the Age Discrimination in Employment Act of 1967, as amended; the Americans with Disabilities Act of 1990, as amended; the
Family and Medical Leave Act of 1993; the Equal Pay Act of 1963; the Worker Adjustment and Retraining Notification Act; the Employee
Retirement Income Security Act of 1974; the Fair Credit Reporting Act; the Minnesota Human Rights Act, any other federal, state or local
anti−discrimination acts, state wage payment statutes and non−interference or non−retaliation statutes.
d. All claims for alleged wrongful discharge; breach of contract; breach of implied contract; failure to keep any promise; breach of a covenant of
good faith and fair