Republic of the Philippines )

City of Davao ) S.S.

WAIVER OF RIGHTS

I, CHONA LIM BARCENA, married, of legal age, Filipino, and a resident

of Eagle St. Marfori St., Davao City, Philippines, after being duly sworn to in
accordance with law, do hereby depose and state;

1. That ROSA D LIM is my mother;

2. That I am the sister of RONALDO D LIM;

3. That my brother died last May 17, 2016 in Davao City;

4. That I paid for the memorial services worth sixty thousand

pesos (Php 60,000) to Cosmopolitan Funeral Homes,
referred to the receipt attached therein;

5. That I waive my rights in claiming the OWWA benefits

worth twenty thousand pesos (Php 20,000) in favor of my
mother ROSA D LIM;

6. That I execute this affidavit with my own free will;

7. I am executing this Affidavit in good faith, for whatever legal

purpose it may serve and to attest to the veracity of the
foregoing;

IN WITNESS WHEREOF, I have hereunto set my hand this July 4, 2016,

2016 at Davao City, Philippines.

CHONA LIM BARCENA

Affiant
DL- l02-06-007827

SUBSCRIBED AND SWORN TO before me, this July 4, 2016 at Davao City,
Philippines, affiant personally appeared to me.

Doc. No.:
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Series of 2016