REPUBLIC OF THE PHILIPPINES )

BANGUED, ABRA ) S.S

AFFIDAVIT OF WAIVER OF RIGHTS

I, ___________________, of legal age, Filipino citizen and a resident

_________________, after having duly sworn in accordance with law, do hereby depose and
state the following:

1. That I am the ___________ of the deceased _______________ who died

intestate on ______________ at ___________________;

2. That by virtue of these present, I, _______________, am waiving any and all

my rights, interest, and participation, to the claim for the _________________ of
the deceased in favor of __________________, and that she may now claim and
receive any and all proceeds thereof.

3. I am executing this Affidavit to attest to the truthfulness of the foregoing, and for
all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto voluntarily and knowingly signed this

affidavit, this ____ at Bangued, Abra.

_______________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _________ affiant ABSALON P.

SORELO, exhibited to me his _______ ID no. ______________, issued at
__________________ on ________________.

Doc. No. __
Page No. __
Book No. __
Series of 2023