HQP-PFF-032

(V03, 08/2017)

WAIVER OF RIGHTS

I, ________________________ of legal age, married/single, (citizenship),

resident of ________________________________, state that:

1. On ________________Mr./Ms. ____________________ passed away;

2. The deceased was a member of the Home Development Mutual Fund

(HDMF);

3. I am an heir of the deceased being his/her ____________________;

4. I hereby waive in favor of _________________________ all rights and

interest I may have over the provident benefits due the deceased from the
HDMF;

5. I hereby release and discharge the HDMF from any and all liability in
connection with the aforementioned waiver and release of the provident
benefits in favor of the above named person/s;

6. I am executing this affidavit to attest to the truth of the foregoing facts and
statements.

I further sayeth not.

_______________________
Affiant

Witnesses:

_________________________ __________________________
Printed Name/Signature Printed Name/Signature

SUBSCRIBED AND SWORN to before me in the ___________________ this

_______ day of ________________, __________ by _____________________, who
has satisfactorily proven to me his/her identity through his/her
______________________________ valid until ________________________, that
he/she is the same person who personally signed before me the foregoing Waiver of
Rights and acknowledged that he/she executed the same.

NOTARY PUBLIC

Doc. No. ____________;

Page No. ____________;
Book No. ____________;
Series of ____________.