REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

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WAIVER OF RIGHTS

I, EDWIN V. MADRONA, JR., of legal age, Filipino, and a resident of Brgy.

Baldoza, Lapaz, Iloilo City, Philippines, after being duly sworn to in accordance with law,
hereby depose and state:

1. That I am the grandmother of ALOHDIA JHERACE MADRONA, a minor

born on October 23, 2012, who has an interest in the Overseas Workers Welfare
Administration (OWWA) insurance/benefits proceeds of my daughter, the late
Mary Grace Adorio, an Overseas Filipino Worker (OFW) who died on December
24, 2017 at UAE, Dubai;

2. That I have been the guardian of Alohdia Jherace Madrona since birth and she is
presently under my care and custody;

3. I am competent to receive in behalf of the said Alohdia Jherace Madrona any

amount/s due her;

4. I have not been diagnosed nor committed to a hospital or institution for imbecile,
insane, a vagrant or vicious person. I am not a habitual drunkard or a habitual
criminal, and have not abandoned, neglected or refused to support said minor/s
or caused him/her/them to commit offenses against the law;

5. That this affidavit is being made to prove that I am the guardian of Alohdia
Jherace Madrona, having the authority to receive whatever benefits due her, as a
requirement to claim the benefits of the Overseas Workers Welfare
Administration (OWWA) and for whatever legal purposes it may serve;

6. That each and every fact herein stated are true and I am willing to testify before
any court of justice to substantiate the truth of each and all the said facts.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________ at Iloilo City, Philippines.

JONALYN G. ADORIO
Affiant

SUBSCRIBED AND SWORN to before me a Notary Public commissioned in the

Province and City of Iloilo, Philippines this ________________ in Iloilo City, Philippines.
Affiant JONALYN G. ADORIO appeared with her I.D. No 11-200245576-8 issued by
PhilHealth whom personally known to be the same person to the Notary Public or identified
by the Notary Public through competent evidence of identity as defined by the 2004 Rules on
Notarial Practice pursuant Supreme Court EN BANC A.M. No. 02.8.13 SC Resolution. That
the herein person represented to the Notary Public that her signature on the instrument or
document was voluntarily affixed by her.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.