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REPUBLIC OF THE PHILIPPINES

PROVINCE OF DAVAO DEL NORTE
ISLAND GARDEN CITY OF SAMAL

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SSS

WAIVER AND RELINQUISHMENT OF RIGHTS
I, ________________, of legal age, Filipino, married and a resident of
Peñaplata, Samal District, Samal City, Philippines, after having been
sworn to in accordance with law, depose and say:
1.

That I am the registered owner of that parcel of land situated

in Barangay Del Monte, Samal City, described as Lot ___________________
containing an area of One Hundred Forty Seven Thousand Six Hundred
Thirty (147,630) Square Meters;
2.

That portions of said area have been disposed to other

persons and the rest remained still in my name;
3.

That when I caused the actual relocation survey for purposes of

designating individual lots of owners/awardees of portions thereof, it was
disclosed that an excess thereof was noted with an area of 24,512 square
meters or 2.4512 hectares, more or less, designated as Lot 52 of said plan;
4.

That said excess area has never been worked or occupied by

farmworkers and the same remained vacant adjacent to my land;
5.

That since my land area complies with the minimum requirements

allowed by law, I waive and relinquish as it is hereby WAIVED and
RELINQUISHED all my rights and interest in acquiring said area and the same be
subject to acquisition by interested and qualified applicants.

IN WITNESS HEREOF, I have hereunto set my hand this
_____________ in Babak, Island Garden City of Samal, Philippines.

Affiant
Res. Cert No.: 10482780
Issued at Samal City
On 1-7-2013
SIGNED IN THE PRESENCE OF:
RUDY MAHINAY

and

PABLITA RAFAEL

SUBSCRIBED AND SWORN to before me this _______________ in
Babak, Island Garden City of Samal, Philippines, affiant exhibited to me
his residence certificate, number of which is clearly written as above
indicated.
MARDOCHEO S. CAMPOREDONDO

No.Doc. 2013 PTR No. Notary Public Until December 31. Page No. 4982907 issued at Samal City on January TIN 880-114-418-669 . _______. 2013 Series of 2013. Book No. _______. _______. 2.