Republic of the Philippines )

City of Tacloban . . . . . . . . . ) S.S.

WAIVER OF RIGHTS TO CLAIM

I, VIRGILIO G. DURAN, of legal age, Filipino, and resident of Brgy.
Santan, Sta. Rita, Samar, after having been duly sworn to in accordance with
law, hereby depose and say:

That I am the legal spouse of the late THELMA B. DURAN who passed away
last September 22, 2014 at the Divine Word Hospital, Tacloban City;

That upon her death, it was my daughter SHIRLEE B. DURAN-ZETA who

shouldered the funeral expenses, since she has a fully paid Memorial Plan
with the St. Peter Life Plan, Inc., and had it reassigned to her mother;

That the above-named deceased was a member/retiree of the Government

Service Insurance System during her lifetime; and as such, one of its
benefits is the funeral/burial claim;

That being the one who paid for the reassigned memorial plan, my
daughter SHIRLEE B. DURAN-ZETA, is entitled for the said claim;

That for reasons of gratuity and generosity, I hereby waive all my

rights and interest to claim the Funeral/Burial Benefits of the afore-
mentioned deceased with the GSIS in favor of my daughter, SHIRLEE B. DURAN-
ZETA;

That I execute this waiver, freely and voluntarily to attest to the

foregoing facts and statements and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13 th day

of October, 2014, in Tacloban City, Leyte, Philippines.

VIRGILIO G. DURAN
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of October, 2014, in

Tacloban City, Leyte, Philippines.

________________________
Administering Officer