Republic of the Philippines )

Imus, Cavite ) S.S.

WAIVER OF RIGHTS TO CLAIM

I, MANOLITO DE QUIROZ, of legal age, Filipino, and resident of Bucandala

5, Imus, Cavite, after having been duly sworn to in accordance with law, hereby depose
and say:

That I am the legal spouse of the late AMELIA BOYLES DE QUIROZ, who
passed away last June 16, 2018 in Ubay, Bohol;

That upon her death, it was her sister LUZ BOYLES CADERAO who
shouldered all the funeral expenses;

That the above-named deceased was a member of the Government Service

Insurance System during her lifetime; and as such, one of its benefits is the
funeral/burial claim;

That being the one who paid for all the funeral expenses, her sister LUZ
BOYLES CADERAO, is entitled for the said claim;

That for reasons of gratuity and generosity, I hereby waive all my rights and
interest to claim the Funeral/Burial Benefits of the afore-mentioned deceased with the
GSIS in favor of LUZ BOYLES CADERAO ;

That I execute this waiver, freely and voluntarily to attest to the foregoing facts
and statements and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 20th day

of August, 2018, in Imus, Cavite, Philippines.

MANOLITO DE QUIROZ
Affiant
 SUBSCRIBED AND SWORN to before me this 20th day of August, 2018, in
Imus, Cavite, Philippines. Affiant exhibited his _________________ , issued on
______________ at ____________________.

Doc No. _______

Page No. ______
Book No. ______
Series of 2018