Republic of the Philippines)

Province of Quezon ) S.S.

x-----------------------------------x

WAIVER OF RIGHTS TO CLAIM

I, CARL CHRISTIAN ABASOLA DE LA CRUZ, of legal age, Filipino Citizen

and resident of Lucena City, Quezon, after having been duly sworn to in accordance with law,
depose and state;

That I am one of the surviving legitimate heirs/beneficiaries of the deceased-

insured GILBERT ESCOBER DE LA CRUZ;

That for reasons of gratuity and generosity, I hereby waive all of my rights and
interest to claim the insurance benefits of the aforementioned deceased-insured, in favor of
KRISTELLE JOY ABASOLA DE LA CRUZ;

That I execute this waiver, freely and voluntarily to attest to the foregoing facts
and statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 30 th day of

September 2020 at _____________________.

CARL CHRISTIAN A. DE LA CRUZ

Affiant

SUBSCRIBED AND SWORN to before me this ______________________, 20____ at

______________________, affiant having exhibited to me their proof of identification.

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