Waiver of Rights - St. Peter - Template

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Republic of the Philippines)

___________________) s.s.
______________)

WAIVER OF RIGHTS

We, ________________, of legal age, Filipino, single, a resident of


_________________________________________ and
______________________________, of legal age, Filipino, married and
a resident of ____________________________________________, after
having been duly sworn to in accordance with law depose and say:

1. That we are the legal heirs of the late ___________________, who


died on ______________ at ________________________________;

2. That during her lifetime, she was an active member and a lawful
holder of St. Peter Life Plan with Contract No. ______________;

3. That I, ________________ do hereby waive, relinquish, quitclaim


and renounce any and all of my rights and interests, whatsoever, over
the aforesaid Life Plan Insurance in favor of my sister,
______________________.

IN WITNESS WHEREOF, we have hereunto affixed our signatures


this ___________ at __________________________.

__________________ _________________
Affiant Affiant
I.D. No. I.D. No.

SUBSCRIBED AND SWORN TO before me this ______________ at


_______________________________.

Doc. No.
Page No.
Book No.
Series of 2017

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