REPUBLIC OF THE PHILIPPINES)

BACOLOD CITY ) S.S.

WAIVER/ TRANSFER OF RIGHTS

We, _________________ and _________________________,

both of legal ages, Filipinos, married to each other and
residing at _________________________________, do hereby
depose and say that:

1. We hereby terminate the water services rendered to us by

Talisay Water District Authority and transfer the same to
____________________ married to ________________________

2. We hereby waive and transfer our right to use, dispose,

etc., all pieces of equipment, facilities and other
materials in our possession which we have acquired in favor
of ___________________________; and

3. We hereby further attest that We execute this WAIVER/

TRANSFER OF RIGHTS freely and voluntarily, based on our own
personal knowledge.

IN WITNESS WHEREOF, we have hereunto signed our name

this ___ day of ________________, 2022 at Bacolod City,
Philippines.

_____________________ ___________________
Affiant Affiant

WITNESSES:

_______________________ _______________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

BACOLOD CITY ) S.S.

BEFORE ME, this _____ day of _____________, 20__,

personally appeared the above-named persons who are known to
me to be the same person who executed the foregoing
instrument and acknowledged to me and that the same is their
own voluntary act and deed.

WITNESS MY HAND AND SEAL.

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of 20__.