WAIVER OF RIGHTS

I, ________KRIZ RAEL YVES L. PUGAL__________ of legal age, single, Filipino resident of

#23 CENTRAL WEST, BAUANG, LA UNION state that:

1. On JUNE 6, 2019 Mr. ROLANDO RENATO A. PUGAL passed away;

2. The deceased was a permanent employee of the Department of Education Region I,

Flores St., Catbangen, San Fernando City, La Union;

3. I am an heir of the deceased being his SON;

4. I hereby waive in favor of MRS. LETICIA L. PUGAL all rights and interest I may have over
the benefits due to the deceased from the Department of Education Region I;

5. 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 _____________.