DEED OF WAIVER OF RIGHTS

KNOW ALL MEN BY THSES PRESENTS

That this Waiver of Rights is being executed this ________ day of _____ 2018 in
_____________, by and between:

We, JUANA DELA CRUZ, PETER DELA CRUZ, PAUL DELA CRUZ and
MARY DELA CRUZ, of legal ages, Filipino citizens and residing at 29 A. Roxas Street,
Tabing Ilog, Marilao, Bulacan, after being sworn to in accordance with law, depose and
state that:

1. We are the surviving heirs of JUAN DELA CRUZ who died on July 1, 2018 at
San Juan De Dios Hospital located at Roxas Blvd. Pasay City. A copy of his
Death Certificate is herein attached as Annex “A”;
2. During his lifetime, he was appointed as _________________ in the
______________________________. Hence, entitled to a terminal pay in the
amount of _____________ pesos (P____.00);
3. I, JUANA DELA CRUZ, spouse of the deceased, do hereby waive, transfer
and convey my right, interest and obligation over the terminal pay entitled
for my above deceased spouse;
4. This waiver is being executed in favor of our children, namely: PETER DELA
CRUZ, PAUL DELA CRUZ and MARY DELA CRUZ and, who affixed their
signature herein below as manifested and their acceptance of the same and
hereby assumes any obligation that may arise with said claim.

IN WITNESS WHEREOF, we have hereunto set our hands this ___ day of
_______, 2018 in _____________________________, Philippines.

JUANA DELA CRUZ PETER DELA CRUZ

Affiant Affiant
ID No: __________________ ID No: __________________
Issued on ________________ Issued on ________________
Issued at ________________ Issued at ________________

PAUL DELA CRUZ MARY DELA CRUZ

Affiant Affiant
ID No: __________________ ID No: __________________
Issued on ________________ Issued on ________________
Issued at ________________ Issued at ________________
 SUBSCRIBED ANF SWORN TO before me this ____ day of _______, 2018 in
_______________________, Philippines, affiants exhibiting to me their competent
evidence of identity indicated below her printed name, bearing her picture and
signature appearing therein.

NOTARY PUBLIC

Doc no: _________

Page no: ________
Book no. ________
Series of 2018