Republic of the Philippines)

____________________) S.S

AFFIDAVIT OF WAIVER OF RIGHTS

I, ___________________________, of legal age, single/married, Filipino, with postal address at

Block ___ Lot ___ of SAN NICOLAS HOMEOWNERS ASSOCIATION INC., ROLLING HILLS, SAN NICOLAS,
BAMBAN, TARLAC, after having been duly sworn to in accordance with, hereby depose and say:

That I am the owner of rights over a certain lot situated at Block ___, Lot ___ of SAN
NICOLAS HOMEOWNERS ASSOCIATION INC., ROLLING HILLS, SAN NICOLAS, BAMBAN, TARLAC,
containing an area of _________________________ (___) square meters;
That considering the fact that I am no longer interested to the said lot and has failed to
comply with the requirements of the Community Association and financial obligation, I desire to
transfer the same to another person;
That such as, I am waving all my rights, interest and participation over the same in favor
of _______________________, likewise of legal age, single/married to
_____________________, and with residence and postal address at
________________________;
That the said ____________________ is willing to assume all obligations with the
Community Association and with the Social Housing Finance Corporation in connection with the
above-mentioned lot.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of

____________________ at ____________________, Philippines.

_____________________ _____________________
Affiant Marital Consent
CTC No. ______________ CTC No. ______________
Issued on _____________ Issued on _____________
Issued at _____________ Issued at _____________

SIGNED IN THE PRESENCE OF:

_______________________________ _______________________________

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in

_______________________ this ______ day of _________________ 20___, affiant exhibiting to me
his/her Community Tax Certificate No. __________________, issued on ____________________, at
_________________, Philippines.

NOTARY PUBLIC
Doc. No. ________
Book No. ________
Page No. ________
Series of ________