REPUBLIC OF THE PHILIPPINES

OFFICE OF THE BARANGAY COUNCIL

WAIVER OF RIGHTS FOR ELECTRIC SERVICES CONNECTION FOR DECEASED MISSING

MEMBER-CONSUMER

I MELBA Q. PALAD, applicant of change of name in electric service connection of the Misamis
Occidental II Electric Cooperative, Inc. (MOELCI-II) located in Purok 1 Baybay Mantic ,
Tangub City with the account name PALAD, RODULFO (A), having account number
20652050 and meter number 209NM069494 . I have been using the electric service connection
mentioned above since the deceased of my father (year 2009) because I am living the said
residence and also paying the electric bills.

Furthermore, I waive my rights if in case someone/somebody will contest my application of

change of name and agreed that after giving notice and time to prove my ownership, the name
electric service will be restored to its original account name.

This waiver of rights is made only for change in the electric service connection purposes.

_____________________

Member-Consumer

Certified by:

______________________

Barangay Captain

Witness by:

1.

2.