REPUBLIC OF THE PHILIPPINES)

_________________________ ) S.S.

WAIVER OF RIGHTS
I/WE,___________________________; _____________________________________;
______________________________________; __________________________________, all
of legal age, and residents of _________________________________________________;
______________________________________; ______________________________________,
respectively, after having been duly sworn to in accordance with law, hereby
depose and state, THAT:

1. We are the legal heirs of the late, ___________________________________

who died on ______________;

2. As legal heirs of the deceased and for reasons of gratuity and generosity,
we hereby WAIVE whatever share, interests or rights we may have in the
proceeds of the account/s of our late mother/father _________________________
with AFPSLAI in favor of our mother/father/brother/sister _______________________;

3. We are executing this WAIVER OF RIGHTS in connection with the

application for termination of membership of our late mother/father,
brother/sister ______________________________ with AFPSLAI;

4. We hold AFPSLAI free and harmless from any and all liability in relation to
this waiver;

5. Further, we are executing this Waiver freely and voluntarily to attest to the
truthfulness of the above facts and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I/We have hereunto set our hands this ______ day of
_____________ 20___ at _______________________________.

_____________________________ _____________________________
Affiant Affiant

___ __________________________
Affiant

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

___________________________ ) s.s.

BEFORE ME, a Notary Public for and in _____________ this _____ day of
__________ 20____, personally appeared:
NAME Valid ID/ Place and Date of Issue
_______________________ _______________________________________
_______________________ _______________________________________
_______________________ _______________________________________

known to me and to me known to be the same person who executed the

foregoing instrument and acknowledged the same to be their free and voluntary
act and deed.

Doc. No: _____

Page No: _____
Book No: _____
Series of 20___.