REPUBLIC OF THE PHILIPPINES )

CITY OF CAGAYAN DE ORO ) s.s.

AFFIDAVIT OF HEIRSHIP and WAIVER OF CLAIMS

I, JEAN NIEPES REQUIERME, Filipino, of legal age, single and with

residence at Block 26, Lot 3, Phase 3, Bloomingdale Subdivision, Iponan, Cagayan
de Oro City after being duly sworn to in accordance with law, hereby deposes and
states:

1. That I am one of the three children/legal heir of the late ADELINA NIEPES
REQUIERME, who died on 03 March 2019 at MMG Hospital & Health Services
Cooperative, Tagbilaran City, Bohol;

2. That the deceased is a teacher/employee of the Department of Education

and a member of BOTETAM (Bohol Teachers Tampuhay). Through the latter, her
heirs are entitled to death aid in case of death;

3. That all of us children of ADELINA NIEPES REQUIERME have decided to

allow only JESSICA REQUIERME GAYO, of legal age, Filipino, married and a
resident of Purok 5, San Agustin, Sagabyan, Bohol to process and claim the
benefits of ADELINA NIEPES REQUIERME such as death aid and other claims;

4. Thus, I, JEAN NIEPES REQUIERME, hereby WAIVES AND

RELINQUISHES my interest and participation over the death claim/mutuary aid from
BOTETAM or any Office to which our mother ADELINA NIEPES REQUIERME has
claims in favor of our co-heir JESSICA REQUIERME GAYO ;

5. That I am executing this Affidavit for myself and to attest the truth of the
foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my hand, this 19th of June

2019 at the City of Cagayan de Oro.

JEAN NIEPES REQUIERME

PRC REG NO. 0041576
EXPIRES ON 2 February 2021
Issued at Cagayan de Oro City

SUBSCRIBED AND SWORN to before me this 19th of June 2019, affiant

exhibiting to me her competent and credible evidence of identity above-
mentioned.

Doc No. 91;

Page No. 19;

Book No. VII;

Series of 2019.