Republic of the Philippines )

Province of Negros Oriental) S.S.

Municipality of Sibulan . . . .)
WAIVER OF RIGHTS
I, ENGVAR TURTAL, of legal age, married, Filipino, and with
residence and postal address at Brgy. Cangmating, Sibulan,
Negros Oriental, Philippines, after been duly sworn to in
accordance with law, do hereby depose and say:
That I am an applicant for Temporary Connection to be
issued by the Municipality Mayor of this Municipality;
That I am constructing a residential building made of
indigenous materials and located within this municipality;
That the application for Temporary Connection is intended
only for the use of the above stated residential building and no
other building structure will be electrically supplied;
That the event the above stated condition will be violated, I
hereby give consent to the Local Government of Sibulan to have
full access on my property to disconnect my electrical service
connection and remove any materials and equipment connected
in it;
That the Government Unit of Sibulan owns a parcel of land
situated at Brgy. Cangmating, Sibulan, Negros Oriental;
IN WITNESS WHEREOF, I have hereunto set my hand on this
6 day of June in Sibulan, Negros Oriental, Philippines.
th

ENGVAR TURTAL
Affiant

HON.

EMMANUEL

DIPUTADO
Municipal Mayor

N.