Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of _______ )

AFFIDAVIT OF WAIVER OF RIGHT/QUIT-CLAIM

I, ________________, of legal age, Filipino, widower, residing at _____________

Philippines, after having been duly sworn to in accordance with law, hereby depose and state:

1. That I was identified by the Department of Agrarian Reform (DAR) as one of the co-
owner farmer-beneficiaries over the agricultural land herein described as follows:

…………
2. That the Department of Agrarian Reform (DAR) erroneously identified me as one of
the co-owner farmer-beneficiaries of the above described agricultural land because I
never possessed nor cultivated it;

3. That in truth and in fact, it was the heirs of ____________, namely; ___________,
_________ and ____________ who actually possessed and cultivated it;

4. That the undersigned Affiant/Declarant, do hereby WAIVE AND QUIT-CLAIM and

forever relinquish my rights, shares, interests and participation over the above-
mentioned/described real property in favor of the above-named _________;

5. That I am executing this Affidavit of Waiver of Right/Quit-Claim in favor of said Heirs

of __________, to attest to the truth of the foregoing facts, for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand, this ____ day of _____ 2022, in
____________________, Philippines.

___________________
Affiant/Declarant
OSCA-ID# ______
Issued on: _________
Date of Birth: _________

SUBSCRIBED and SWORN to before me, on the day, year and place above written.

Doc. No. ______; ___________________________

Page No. ______; Notary Public/Province of Leyte
Book No. ______;
Series of ______