Republic of the Philippines )

Province of Northern Samar ) S.S.

Municipality of _____________ )

AFFIDAVIT OF WAIVER

I, _________________, of legal age, single, Filipino, and a resident of Brgy.

________________, __________________Northern Samar after having been
duly sworn on oath in accordance with law, hereby deposes and says:

That I am a Farmer Beneficiary under the Comprehensive Agrarian Reform

Program and I was awarded with a parcel of agricultural land situated at Brgy.
_________________, _____________Northern Samar, with an area of _______
square meters covered by O-CLOA/T-CLOA-______ designated as Lot No.
____________.

That I know for a fact that I am not the actual tiller and cultivator of the said
landholding awarded to me;

That I can further attest that I was erroneously identified as farmer beneficiary
on the said landholding;

That I hereby relinquish, waive and quit-claim whatever rights or interest over
the said landholding in favor of ____________________________;

That I am voluntarily executing this SWORN STATEMENT to attest to the

truthfulness of the foregoing statements and for whatever legal purposes it may serve
best in favor of any interested party.

AFFIANT FURTHER SAYETN NAUGHT.

IN TRUTH WHEREOF, I have hereunto set my hands this ___ day of

____________ 2021 at Catarman, Northern Samar.

_____________________
Affiant
CEI:_____________________

SUBSCRIBED AND SWORN to before me this ___ day of _____________

2021 at _________________, Northern Samar. Affiant personally appeared before
me and known to be the same person who executed the foregoing instrument.

Doc No.________;
Page No._______;
Book No._______;
Series of 2021.