Republic of the Philippines)

City of Davao . . . . . . . . .)s.s.

X---------------/

WAIVER

I, RODOLFO M. BUALAN, of legal age, Filipino, widower and a resident of

______________, Davao City, Philippines, after having sworn in accordance with law,
hereby depose and state:

1. That the insured Mrs. Procesa __. Bualan under Policy No. ______________,
a former employee of ________________________ died at
______________________ on _________________________;

2. That I am the surviving legal spouse and the legal heir designated beneficiary
of the deceased insured;

3. That I am Waiving my right to claim the Death Benefits of the deceased

insured in favor my daughter MITZI GAY BUALAN FERRARIZ;

4. That I am executing this waiver in support of our application for the Death
Benefit Claim with GSIS, to attest to the truth of the foregoing, and for
whatever legal purposes it may serve. I fully understand that any inaccurate
and untruthful statement in this affidavit may render me criminally liable for
PERJURY.

Further Affiant Sayeth Naught.

IN WITNESS WHEREOF, I have hereunto set our hands this ___________ at

Davao City, Philippines.

RODOLFO M. BUALAN
Affiant
Competent Proof of Identity: ______________________

SUBSCRIBED AND SWORN TO BEFORE ME this ____________ at Davao City,

Philippines, affiants exhibited to me his competent proof identity.

Doc No.___;
Page No.___;
Book No.___;
Series of 2016