REPUBLIC OF THE PHILIPPINES)

CITY OF __________________    ) S.S.

WAIVER OF RIGHTS 
 
            I, (NAME OF AFFIANT) of legal age, Filipino, single/married, and a resident
of (Address of Affiant), after having been sworn to in accordance with law, do hereby
depose and state that:
 
1. I and my sibling namely (Name of Siblings) are the legal heirs of our father, the
late (NAME OF FATHER), who died on (Date of Death) at (Place of Death) due
to (Cause of Death).
 
2. My late father (NAME OF FATHER) was a member of (Name of Company) and
was entitled for benefits upon his death.
 
3. I hereby waive all my rights to claim the proceeds of said benefits that may be
due to me arising from the death of my father (NAME OF FATHER), in favor of
my siblings.
 
4. Thus, I am requesting (Name of Company) to allow any of my siblings  to receive
the proceeds of the said benefits which may be due to me upon the death of our
father the late (NAME OF FATHER).
 
5. I free (Name of Company) from any liability relative thereon, and I will hold myself
criminally and civilly responsible for any liability that may arise in connection with
the said waiver of the aforementioned benefits. 
 
6. I am executing this Affidavit in order to attest to the truth of the foregoing facts
and for whatever legal purpose this may serve. 
 
IN WITNESS WHEREOF, we have hereunto set our hands this (Date) at (Place).
 
 

(NAME OF AFFIANT)
Heir
 
 
            SUBSCRIBED AND SWORN to before me this (Date) at (Place of Notarization),
Philippines, affiant personally appeared and exhibited his competent evidence of
identity (ID Number and other Details) which bear his photograph and signature. 
 
 
 
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.