REPUBLIC OF THE PHILIPPINES }
} S.s.
WAIVER OF PRE-EMPTIVE RIGHTS
We, the undersigned stockholders of [NAME OF THE COMPANY],
after having been duly sworn in accordance with law, hereby depose and
state that:
1. We are the stockholders of [NAME OF THE COMPANY];
2. On [DATE OF MEETING], during a special stockholders’ meeting
at [PLACE OF MEETING] we waived our pre-emptive rights to purchase the
newly issued [NUMBER OF SHARES IN WORDS] (NUMBER OF SHARES IN
FIGURES) shares of stock in the amount of [AMOUNT IN WORDS]
(PhP__________) from the authorized capital stock of [NAME OF THE
COMPANY] in favor of [NAME OF THE PERSON TO WHOM THE WAIVER IS
EXECUTED IN FAVOR OF].
3. We have waived and affirmed the waiver of our rights to
purchase the newly issued shares from the authorized capital stock of [NAME
OF THE COMPANY].
4. We are executing this affidavit to attest to the truth of the
foregoing and for all legal intent and purposes.
IN WITNESS WHEREOF, we have hereunto set our hands this
___________________ in ________________________.
[NAME OF THE STOCKHOLDER] [NAME OF THE STOCKHOLDER]
TIN TIN
[NAME OF THE STOCKHOLDER] [NAME OF THE STOCKHOLDER]
TIN TIN
[NAME OF THE STOCKHOLDER] [NAME OF THE STOCKHOLDER]
TIN TIN
[NAME OF THE STOCKHOLDER]
TIN
REPUBLIC OF THE PHILIPPINES ]
__________________________ ] S.S.
SUBSCRIBED AND SWORN to before me this
___________________ at _______________________________, affiants
exhibited to me their TIN Nos.
NAME TIN. NO.
1. TIN
2. TIN
3. TIN
4. TIN
5. TIN
6. TIN
7. TIN
IN WITNESS WHEREOF, I have hereunto set my hand and affixed
my notarial seal on the place, date and year above written.
NOTARY PUBLIC
Until December 31, 20__
Doc. No. ____
Page No. ____
Book No. ____
Series of 20__.