WAIVER

I, ________________, of legal age, a resident of ________________ and presently employed in the Provincial
Government of Cagayan with the position of _________________________ and assigned in the Sangguniang
Panlalawigan Office, DO HEREBY WAIVE my right to a monthly net take home of P4,000.00 as provided for
under the General Appropriations Act of 2017.

This waiver is being executed in view of the fact that the undersigned, even prior to the issuance of the
above-mentioned order, has a net take home pay lower than P4,000.00. The deductions made and which
are needed to be carried over on the undersigneds monthly salary are amortizations or payments to loans
or obligations incurred from the GSIS and the HDMF. It must be emphasized that the undersigned has only
two existing loans, the GSIS and the HDMF, but both institutions do not allow over-the-counter payments
but only payroll deductions and that said institutions are likewise in the priority list of authorized
deductions from an employees salary. Furthermore and more importantly, to not allow the deduction of
payments to GSIS and HDMF loans might have implications on the contractual agreements between the
undersigned and the said institutions, among others, the giving rise to a penalty or the prolonging of the
contract of loan, hence the necessity of this Waiver.

In view thereof, I GIVE FULL AUTHORITY to the Accounting and Treasury Office to effect the corresponding
deductions in our payroll in payment of my monthly amortization for the existing loans I contracted with
lending institutions with which the Provincial Government is likewise a subsidiary party thereto.