WAIVER OF RIGHTS

I, the undersigned, of legal age, heir of the late _ROEL AMARILLA______, state
that:
1. On _JULY 15, 2023___ Mr. _ROEL D. AMARILLA__ passed away;
2. The deceased was a Government Service Insurance System (GSIS) member and
has unclaimed member’s savings at the time of his death;
3. I am an heir of the deceased member;
4. I hereby waive in favor of __JOCELYN D. AMARILLA(mother of the deceased)_
all rights and interest that I may have over the provident benefits due the
deceased from the Government Service Insurance System (GSIS);
5. I hereby release and forever discharge Government Service Insurance System
(GSIS) from any and all claim or liability from my co-heirs and/or any other third-
party claimant in connection with the aforementioned waiver and release of the
provident benefits in favor of the above-named person/s;
6. I am executing this affidavit to attest to the truth of the foregoing facts and
statements.
7. Given are the name, relationship, and signature of the heir of the deceased
waiving his rights and interest over the provident benefits due from the
Government Service Insurance System (GSIS):
Name of Heir Relationship Signature
1. __BENEDICTO AMARILLA____ FATHER of the Deceased __________
SUBSCRIBED AND SWORN to before me this _______________________ by the
following person/persons, who are known to me or whom I have identified
through competent evidence of identity:
Name I.D. Expiration
1._BENEDICTO AMARILLA__ ________________ ________________
he is the person who personally signed before me the foregoing Waiver of Rights
and acknowledged that he executed the same.

NOTARY PUBLIC

Doc. No. ____________;

Page No. ____________;
Book No. ____________;
Series of ____________.