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    Waiver: I, JOSEFA T. ROLLORATA, of Legal Age, Filipino, and A Resident of 101-A Candelaria

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    bubblingbrook
    Josefa T. Rollorata waived her right to reimbursement of 6,800 pesos for funeral services provided by Angel B. Brillantes Jr. Funeral Homes, Inc. for Anthony Ting. This waiver was made in a service contract dated December 10, 2013. Josefa executed an affidavit on December 20, 2013 in Davao City to attest to waiving reimbursement in order to process Anthony Ting's funeral claim application with the Social Security System.

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    Waiver: I, JOSEFA T. ROLLORATA, of Legal Age, Filipino, and A Resident of 101-A Candelaria

    Uploaded by

    bubblingbrook
    124 views1 page
    Josefa T. Rollorata waived her right to reimbursement of 6,800 pesos for funeral services provided by Angel B. Brillantes Jr. Funeral Homes, Inc. for Anthony Ting. This waiver was made in a service contract dated December 10, 2013. Josefa executed an affidavit on December 20, 2013 in Davao City to attest to waiving reimbursement in order to process Anthony Ting's funeral claim application with the Social Security System.

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    Original Title

    Waiver

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    Josefa T. Rollorata waived her right to reimbursement of 6,800 pesos for funeral services provided by Angel B. Brillantes Jr. Funeral Homes, Inc. for Anthony Ting. This waiver was made in a service contract dated December 10, 2013. Josefa executed an affidavit on December 20, 2013 in Davao City to attest to waiving reimbursement in order to process Anthony Ting's funeral claim application with the Social Security System.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    124 views1 page

    Waiver: I, JOSEFA T. ROLLORATA, of Legal Age, Filipino, and A Resident of 101-A Candelaria

    Uploaded by

    bubblingbrook
    Josefa T. Rollorata waived her right to reimbursement of 6,800 pesos for funeral services provided by Angel B. Brillantes Jr. Funeral Homes, Inc. for Anthony Ting. This waiver was made in a service contract dated December 10, 2013. Josefa executed an affidavit on December 20, 2013 in Davao City to attest to waiving reimbursement in order to process Anthony Ting's funeral claim application with the Social Security System.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 1

    REPUBLIC OF THE PHILIPPINES)

    CITY OF DAVAO ) S.S.


    x------------------------------------x

    WAIVER
    I, JOSEFA T. ROLLORATA,

    of legal age, Filipino, and a resident of 101-A Candelaria

    Extension, Kabacan, Matina, Davao City, after having been duly sworn to in accordance with law,
    depose and state THAT:
    1. I am waiving my right for reimbursement for the amount of SIX THOUSAND EIGHT HUNDRED
    PESOS (P 6,800.00) as payment for the services of Angel B. Brillantes Jr. Funeral Homes, Inc. in favor
    of ANTHONY TING;
    2. Such payment is evidenced by a Service Contract dated December 10, 2013;
    4. I am executing this affidavit to attest to the foregoing facts and for the purpose of processing the
    deceaseds funeral claim application with the Social Security System.
    IN WITNESS WHEREOF, we have hereunto set our hands this 20th day of December, 2013,
    in Davao City, Philippines.

    JOSEFA T. ROLLORATA
    Affiant

    SUBCRIBED

    AND

    SWORN

    TO before

    me

    this ___________________ in

    _________________, Philippines, affiants exhibiting to me their valid proofs of identification.

    Doc. No. _____;


    Page No. _____;
    Book No. _____;
    Series of 2013.

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