Republic of the Philippines )

City of Zamboanga ) S.S.

WAIVER OF RIGHTS

I, ___, of legal age, Filipino, single, and presently residing at __, after having
been duly sworn to in accordance with law, hereby depose and say:

1. That I am a legal heir of the late __, who died on __ at Zamboanga City;

2. That during his lifetime, he was an active member and a lawful holder of St.
Peter Life Plan with Contract No. __;

3. That I, ___ do hereby waive, relinquish, quitclaim and renounce any and all of
my rights and interests, whatsoever, over the aforesaid Life Insurance in favor
of my mother, __;

IN WITNESS WHEREOF, we have hereunto set our hands this __ day of __

2023 at __.

___
Affiant

SUBSCRIBED AND SWORN to before me, this ___ day of ___ 2023 in
___ , Philippines, affiant having exhibited to me his ___ issued at ____.

Notary

Doc. No. : _____;

Page No.: _____;
Book No.: _____;
Series of 2023