Republic of the Philippines

} s.s.
Pateros, Metro Manila

WAIVER OF RIGHTS

We, ANA M. CRUZ and BEA L. CRUZ, both of legal age, Filipino,
single, residents of 192 P. Rosales Street, Brgy. Santa Ana, Pateros, Metro
Manila, after having been sworn to in accordance with law, depose and state
that:
1. We are the designated beneficiaries of the late TEODORO M. CRUZ
who died on August 19, 2021 in Quezon City.
2. During his lifetime, he was a lawful holder of St. Peter Life Plan
identified as “St. Dorothy Life Plan Plus under Contract Number XXXXXXX
with plan value of Php30,000.00”.
3. We do hereby waive, relinquish and renounce any and all our
rights and interests, whatsoever, over the said plan in favor of JOE CRUZ.
4. We execute this Waiver of Rights to attest to the truthfulness of
the foregoing statements, and to facilitate the transfer of the policy in favor
of JOE CRUZ.

Signed this _______________ at ____________.

ANA M. CRUZ BEA L. CRUZ

Affiant Affiant
UMID CRN 0033-XXXXXX-6 COMELEC VIN 7606-00XXA-
XXXXXX1000

SUBSCRIBED and SWORN to before me, this __________ in

______________, affiant exhibited to their competent evidence of identity.

WITNESS my hand and affixed my notarial seal on the date and place
first above written.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2021.