Republic of the Philippines )

City of Iloilo . . . . . . . . . ) S.S.

WAIVER OF RIGHTS
(TO CLAIM DEATH BENEFITS)

I, CANDELL L MINERVA, of legal age, Filipino, and resident of DB Ledesma Street,

Barangay Our Lady of Lourdes, Jaro, Iloilo City, after having been duly sworn to in accordance
with law, hereby depose and say:

That I was a partner of Lester B. Delfinado, an Overseas Filipino Worker (Seaman) who
passed away last September 21, 2016 while on board a ship en route to Odessa, Ukraine;

That upon his death, he left me a child named Liyana Caitlyn M. Delfinado, who was born
on December 24, 2014. An authenticated copy of the Certificate of Live Birth issued by
Philippine Statistics Authority is hereto attached;

That the above-named deceased was a member of the Overseas Workers Welfare
Association (OWWA) during his lifetime; and as such, one of its benefits is the death claim;

That being the biological mother of the deceased’s daughter who is a minor, I am the legal
guardian of my daughter for all legal intents and purposes;

That I can say that my daughter is legally qualified to receive the death claim of her father;

That the deceased, in his later years, contracted marriage with Ma. Monita P. Delfinado. An
authenticated copy of the Certificate of Marriage issued by the Philippine Statistics Authority is
hereto attached as one of the requirements for processing of claims;

That for reasons of gratuity and generosity and being the legal guardian of the deceased’s
daughter, I hereby waive all our rights and interest to claim the Death benefits of the
aforementioned deceased with the OWWA in favor of his legal wife, MA. MONITA P.
DELFINADO;

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

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27 th day of October,

2020, in Iloilo City, Philippines.

CANDELL L. MINERVA
Affiant

SUBSCRIBED AND SWORN to before me this ________________, in Iloilo City,

Philippines. Affiant exhibited to me her ______________________________ issued at
_________________ and valid until _______________ as proof of her identity.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2020.