WAIVER OF RIGHTS TO CLAIM

I, GRACE ANN DULA y RIVERA, single, of legal age, Filipino, and all resident of Brgy.
Cabintan, Ormoc City, after having been duly sworn to in accordance with law, depose and
state:

1. That I am the surviving legitimate heir/beneficiary of the deceased ABEGAIL DULA y

RIVERA, who died on Oct. 3, 2015 at Ormoc City.

2. That for reasons of gratuity and generosity, I hereby waive all my rights and interests
to claim the INSURANCE PROCEEDS with Perpetual Help Credit Cooperative (PHCCI),
in favour of my father, NOEL DULA y CABUSAS.

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

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of February, 2016 at
Ormoc City, Philippines.

GRACE ANN DULA y RIVERA

REPUBLIC OF THE PHILIPPINES

TACLOBAN CITY S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public and in the above jurisdiction, personally appeared GRACE
ANN DULA y RIVERA with valid Identification as competent evidence of identity:

Known to me and to me known to be the same person who executed and signed the
foregoing Waiver of Rights to Claim, signed by the party and having acknowledged to me that
the same is her free and voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal
this 23rd day of February, 2016 at Ormoc City, Philippines.

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Series of 2016.