WAIVER

KNOW ALL MEN BY THESE PRESENTS:

That I, MA. CECILIA D. BALDEMOR, of legal age, Filipino, single, and with
postal address at Purok 8 Longos, Kalayaan, Laguna under oath do hereby depose and
state:

1. That I am the mother of RICHELLE BALDEMOR, minor, residing at P.

Paterno St., Brgy. 2, Paete, Laguna;

2. That on December 24, 2019, at around 6 o’clock in the morning, I received a

news that my daughter, Richelle died of an apparent suicide;

3. That in order to determine the specific cause of death of my daughter,

authorities require the conduct of an autopsy on the remains of my daughter;

4. That I fully understand that in not performing such autopsy, authorities may
not be able to establish a definite cause of death of my daughter;

5. That I hereby waive our right to the conduct of an autopsy on the remains of
my daughter;

6. That as such, I shall not hold the authorities tasked to conduct an autopsy
liable for any loss, injury, pain or suffering, real or imagined, that may arise
from non-performance of the said autopsy.

IN WITNESS WHEREOF, I have hereunto set my hands this 24 th day of

December 2019, at Paete, Laguna, Philippines.

MA. CECILIA D. BALDEMOR

Affiant
COMELEC Voter’s ID No.
3409-0038A-L2977MDB20000

SIGNED IN THE PRESENCE OF:

_________________________ ___________________________
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LAGUNA )S.S.
MUNICIPALITY OF PAETE )
x-------------------x

BEFORE ME, a Notary Public for and in the Province of Laguna, this 24 th day of
December 2019, personally appeared MA. CECILIA D. BALDEMOR, who has
satisfactorily proven to me her identity through competent evidence of identity, that she
is the same person who executed and voluntarily signed the foregoing WAIVER which
she acknowledged before me as her free and voluntary act deed.

WITNESS MY HAND AND SEAL this 24th day of November 2019 in Paete, Province
of Laguna, Philippines.

Doc. No. 137;

Page No. 29;
Book No. 1;
Series of 2019.