REPUBLIC OF THE PHILIPPINES )

CITY OF HIMAMAYLAN ) S.S.

X---------------------------------------X
WAIVER OF RIGHTS

WE, GEMMA S. ORNILLO, GILBERT D. SALIGAN, VICENTE D. SALIGAN JR., JOEL D.

SALIGAN, and SHEILA MAE S. SALVACION, all of legal age, Filipinos, and a residents of Brgy.
Sara-et and Brgy. Aguisan, respectively, Himamaylan City, Negros Occidental, after having been
sworn in accordance with law, hereby depose and state: THAT

We are the surviving children and legal heirs of deceased CONCHITA DETABLAN
SALIGAN who died on September 20, 2017 at Corazon Locsin Montelibano Memorial Regional
Hospital, Bacolod City, Negros Occidental;

During her lifetime she was a registered member of Social Security System with No. 07-
32200893, and, as such, her legal heirs are entitled to her SSS Burial and Death Benefit Claims
and other claims relative to her death;

That upon her death, it was our uncle JOEMARIE GARDE DETABLAN, who shouldered
the funeral expenses of our said mother;

For reasons of gratuity and generosity, WE, GEMMA S. ORNILLO, GILBERT D. SALIGAN,
VICENTE D. SALIGAN JR., JOEL D. SALIGAN, and SHEILA MAE S. SALVACION, all of legal age,
Filipinos, and a residents of Brgy. Sara-et and Brgy. Aguisan, respectively, Himamaylan City,
Negros Occidental, hereby waive all our rights, interests and participation over SSS Burial and
Death Benefit Claims of the aforementioned deceased, in favor of my uncle JOEMARIE GARDE
DETABLAN;

The WAIVEE, JOEMARIE GARDE DETABLAN, hereby accepts and receives this WAIVER
OF RIGHTS made in his favor and hereby manifests his gratefulness for the latters’ generosity.

IN WITNESS WHEREOF we have hereunto set our hand this 25th day of OCTOBER 2017 at
Himamaylan City, Negros Occidental.

GEMMA S. ORNILLO GILBERT D. SALIGAN VICENTE D. SALIGAN JR.

Waivor Waivor Waivor
__________________ ___________________ __________________

JOEL D. SALIGAN SHEILA MAE S. SALVACION JOEMARIE GARDE DETABLAN

Waivor Waivor Waivee
____________________ ____________________ ____________________

SUBSCRIBED AND SWORN TO before me this 25th day of October 2017 at Himamaylan
City, Negros Occidental, affiants exhibited to me their respective ID’s written below their names
as competent proof of their identities.

CLODUALDO E. SUBALDO JR.

DOC. NO. _____ NOTARY PUBLIC
UNTIL DECEMBER 31, 2017
PAGE NO. ____ FOR THE CITY OF HIMAMAYLAN AND THE MUNICIPALITIES OF
BINALBAGAN AND HINIGARAN, NEGROS OCCIDENTAL
OFFICE AD: AGUISAN, HIMAMAYLAN CITY
BOOK NO. XXXI IBP NO. 1008295 December 11, 2015 – Bacolod City
PTR No. 0346223 January 4, 2016 – Himamaylan City
SERIES OF 2017 ROLL NO. 60199