REPUBLIC OF THE PHILIPPINES )

CIY OF CEBU
) S.S

WAIVER OF RIGHTS

I, JUVI L. CALIVA, Filipino, of legal age married and a resident of Bock 10, Lot
16, Busay Heights, Cebu City, after having been duly sworn to in accordance with law, do
hereby deposes and states :
That I am the owner/planholder of St. Peter Life Plan Policy no 046700161B ;
That for reasons of gratuity and generosity, I hereby waive all my rights and
interests to claim the insurance benefits on my aforementioned life insurance policy in
favor of my cousin ,EVELYN L. JABILLES, through her husband, LUCAS P.
JABILLES.
That I execute this waiver, freely and voluntarily to attest to the foregoing facts
and statements and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have herewith affixed my signatures this
__________ day of ____________________ at _______________________________.

JUVI L. CALIVA
AFFIANT

ACKNOWLEDGMENT
Republic of the Philippines )
City of Cebu
) S.S

BEFORE ME, a Notary Public of Cebu City, personally appeared JUVI L.

CALIVA with her ______________________ bearing no. _____________________
issued on________________________ issued at _____________________________ as
her competent evidence of identity. Known to me and to me known to be the same person
who executed the foregoing document and she acknowledge that the same is her free and
voluntary act and deed.

Notary Public
Doc No. : _______
Page No. :_______
Book No. _______
Series of 2015