Republic of the Philippines)

City of Binan ) S.S.

WAIVER OF RIGHTS

I, ______________________, of legal age, married to

____________________ S and a resident of ____________________, after
having been sworn to in accordance with law, depose and states:

1. That I am the surviving spouse of the late__________________ who

died intestate on ___________________ in Binan City, Laguna.

2. That me and my minor child are the sole and exclusive heirs of late
husband ___________________

3. That my late husband was a ______________________ at

the_____________________;

4. That being the legal heirs of my late husband, my son and I waive our
rights to claim in favor of my husband’s
father___________________________ as the one and only claimant of
any and all benefits due to us as the sole and exclusive heirs;

5. That I execute this Waiver to attest to the truth of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____day of ____________________, in the City of Binan, Philippines.

Affiant
_____________________

SUBSCRIBED AND SWORN to before me this __________, the affiant

having exhibited to me her competent proof identity.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2020.