REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS )
MUNICIPALITY OF BALAYAN ) S.S.

WAIVER

I, MELINDA MAGNAYE APOLITO, of legal age, widow, Filipino and a

resident of Brgy. 4, Balayan, Batangas, after having been duly sworn to in
accordance with law, hereby depose and state that:

1. I am the spouse of Apolinario G. Apolito, who is a GSIS member with

BP No. 2002150972, and we were married last September 26, 1987;

2. Unfortunately, my husband died last July 24, 2021 and as the primary
beneficiary I am supposed to take care of the process needed in order to
facilitate the claim for his funeral benefit;

3. However, since I have a problem regarding my birth certificate I am

allowing my daughter, Menarlyn Apolito Landicho, to be the claimant
of the said funeral benefit upon completion of all the requirements
needed by the GSIS office;

4. I am executing this Waiver to attest to the truth of the foregoing and

that I am fully aware of its effect.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of

July, 2021 at Balayan, Batangas.

MELINDA MAGNAYE APOLITO

Affiant

SUBSCRIBED AND SWORN to before me this 28th day of July, 2021 at

Balayan, Batangas. Affiant exhibited to me his Voter’s ID with No. 1003-0018A-
I0168MMA20000.

ATTY. MYRAFLOR L. CHAVEZ

Public Attorney II
Public Attorney’s Office
Pursuant to RA 9406