Republic of the Philippines )

Province of Bohol ) S.S.

City of Tagbilaran )


AFFIDAVIT OF WAIVER


I, RHEUMER MICHAEL A. ORCULLO, of legal age, Filipino and with postal address at
Purok 3, Manga District, Tagbilaran City, Bohol, after having sworn to in accordance with law,
hereby state that:


1. I am legally married to Jocelyn Cabatos Orcullo, who currently works at the Regional
Trial Court of Bohol, Branch 3, Tagbilaran City;


2. We have a son, Malki C. Orcullo, who was born on August 8, 2013;


3. I let my wife declare our son as qualified dependent child in BIR Form No. 2305 and
consequently, claim the additional exemption and premium deductions; and


4. This Affidavit is executed to attest to the truth of the facts aforestated and further to
confirm my waiver of claim concerning our qualified dependent child for additional exemption
and premium deductions with the BIR.


IN WITNESS WHEREOF, I hereby hereunto set my hand in signing this 28
th
day of
March, 2014, at the City of Tagbilaran, Philippines.
J
J
J
J
J


RHEUMER MICHAEL A. ORCULLO
Affiant


SUBSCRIBED AND SWORN TO before me this 28
th
day of March, 2014, at the City of
Tagbilaran, Philippines.