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Proforma Waiver of Rights

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REPUBLIC OF THE PHILIPPINES)

____________________________) S. S.

AFFIDAVIT OF WAIVER OF RIGHTS

I/ WE, _____________________________ of legal age/s, single/married,


Filipino citizen/s, and resident/s of
___________________________________________, Philippines, after being sworn
in accordance with law, hereby declare that:

1. That I/WE am/ are the beneficiary/ies of the Killed-In-Action (KIA) Off-Base
Housing Program of the government;

2. That I/WE am/ are fully aware that the reservation of the housing unit for KIA
beneficiaries was until 31 December 2018;

3. That I/WE have failed to avail of the said housing unit before or on the said
date, for the following reason/s, to wit:
______________________________________________________________
______________________________________________________________
_____________________________________________________________;
4. As a result of my/our failure to avail of the housing unit, I/ WE am/ are mindful
that the same has been forfeited and thus, I/ WE am/are waiving all my/our
rights, interest and participation over the same in favor of the government;

5. I/WEfurther declare that the government, including the AFPHB, the NHA, and
other offices connected with the implementation of the said Program, or its
officers or staff, shall not be held liable for any claims of ownership over the
said property;

6. I/WE further agree that this WAIVER, RELEASE AND QUITCLAIM may be
pleaded as bar to any suit or proceeding to which either I/we, my/our legal
heirs and assigns, may have against the government, including the AFPHB,
the NHA, or its officers or staff;

7. As such, I/WE finally manifest that I/we have no claim(s) or cause of action
neither against any officer nor against any person connected with the
administration and operation of the said Program;

8. I/WE am/are executing this affidavit to attest to the truth of the foregoing facts
without any intent to circumvent any existing laws and regulations.
IN WITNESS WHEREOF, I/ WE have hereunto set my/our hand/s this ______
day of _____________ at ____________________, Philippines.

_______________________ ______________________
Affiant Affiant
ID No.______________ ID No.________________
Issued on ___________ Issued on _____________
Issued at ____________ Issued at ______________

_______________________ ______________________
Affiant Affiant
ID No._______________ ID No.________________
Issued on ____________ Issued on _____________
Issued at _____________ Issued at ______________

SIGNED IN THE PRESENCE OF:

________________________ _________________________
ID No.______________ ID No._______________
Issued on ___________ Issued on ____________
Issued at ____________ Issued at ____________

SUBCRIBED AND SWORN TO before me this____ day of ______,20__ in


______________, Philippines, affiant exhibiting to me his/her/their government
issued ID above as Competent Evidence of Identity (CEI).

Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 20____.

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