WAIVER OF RIGHTS AND INTEREST

KNOW ALL MEN BY THESE PRESENTS:

We, _____, of legal age, single, Filipino and residing at Calamba City Laguna,____ , of
legal age, single, Filipino and residing at Calamba City Laguna, after having sworn to in
accordance with law, hereby depose and say that:

We have, in accordance with the laws on Intestate Succession, individual claims, interest
and participation on the benefits granted by the Overseas Workers Welfare Administration
(OWWA) in favor of our sister_____, who died on ____at______

We irrevocably WAIVE, RELINQUISH, RENOUNCE, FORFEIT any claim, rights,

share, participation or interests that we have, if any, over the BEEFITS granted by OWWA, in
favor of our brother ____

IN WITNESS WHEREOF, we have hereunto signed this _____ day of _________,

2019, hereat _______________.

____________________ _____________________________

Signed in the Presence of:

_________________ ______________________

ACKNOWLEDGMENT

Republic of the Philippines)

Pasay City ) S.S.

Before me Notary public in Pasay City personally appeared

Valid Govt. I.D. Date/Place Issued

_________________ _________________________
_________________ _________________________
________________ _________________________
known to me to me known to be the same persons who executed the waiver of rights consisting
of two (2) pages including this page where this acknowledgment is written and notarized. They
acknowledged to me that the said document and the waivers made therein is of their free and
voluntary act done with full knowledge of their rights under the law.

NOTARY PUBLIC

Doc. No.:_________;
Page No.:_________;
Book No.:_________;
Series of 2020;