WAIVER OF RIGHTS

We, the undersigned, of legal age, heirs of the late LILIBETH D. SERVAN state
that:
1. On March 30, 2021 Mrs. LILIBETH D. SERVAN passed away;

2. The deceased was a member of Government Service Insurance System

(GSIS) and has unclaimed member’s savings at the time of her death;

3. We are the heirs of the deceased member;

4. We hereby waive in favor of EUSEBIO B. SERVAN, JR. all rights and interest
that we may have over the provident benefits due the deceased from the GSIS;

5. We hereby release and forever discharge GSIS from any and all claim or
liability from our co-heirs and/or any other third-party claimant in connection
with the aforementioned waiver and release of the provident benefits in favor of
the above-named person;

6. We are executing this affidavit to attest to the truth of the foregoing facts
and statements.

7. Given are the names, relationships and signatures of the heirs of the
deceased waiving their rights and interest over the provident benefits due from
GSIS:

Name of Heir Relationship Signature

1. CZARINA SERVAN Daughter _____________________

2. VINCENT PAUL SERVAN Son _____________________

3. PERCY VAL SERVAN Son _____________________

Witnesses:

MARY JANE A. DALIMOT TED F. CORPUZ

SUBSCRIBED AND SWORN to before me this ________ day of _________,

2021 in Diffun, Quirino by the following persons, who are known to me or whom I
have identified through competent evidence of identity:
 Name ID Presented Expiration

1. CZARINA SERVAN Driver’s License No. B12-18-002393 05/06/2023

2. VINCENT PAUL SERVAN PNP ID No. 19H290820 05/24/2022

3. PERCY VAL SERVAN PRC ID Card Reg. No. 0850702 11/12/2021

that they are the same persons who personally signed before me the foregoing
Waiver of Rights and acknowledgment that they executed the same.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2021.