WAIVER OF RIGHTS AND INTEREST
KNOW ALL MEN BY THESE PRESENTS:
We of legal ages, Filipino citizens and a resident
of , as heirs of and beneficiaries in Fortune Life Insurance Co.,
Inc. of the late , our daughter, do these presents,
hereby waive any all of our rights, titles and interest therein as such beneficiaries
therein favor of our son in law, .
By this Waiver of Rights and Interest, We hereby authorize Fortune Life
Insurance Com., Inc. to issue the check/s in payment for the proceeds to and in the
name of our son in law, .
Beneficiary Beneficiary Beneficiary
ID No:_______________ ID No: ______________ ID No.: _____________
Issued on:____________ Issued on:____________ Issued on:___________
Issued at:_____________ Issued at: ____________ Issued at:____________
BEFORE ME, a Notary Public for and in the , this __ day of
_________________, personally appeared the parties with above Identification who is known
to me to be the same person who executed the foregoing instrument and he acknowledge to me
that the same is at his own free and voluntary act and deed.
WITNESS MY HAND AND NOTARIAL SEAL.
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