Hqp-Pff-032 Waiver Of Rights

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HQP-PFF-032
WAIVER OF RIGHTS
I, ________________________ of legal age, married/single, (citizenship), resident of
______________________________, state that:
1. On _______________ Mr./Ms. ____________________ passed away ;
2. The deceased was a member of the Home Development Mutual Fund (HDMF);
3. I am an heir of the deceased being his/her _____________________;
4. I hereby waive in favor of ____________________________all rights and interest I
may have over the provident benefits due the deceased from the HDMF;
5. I hereby release and discharge the HDMF from any and all liability in connection
with the aforementioned waiver and release of the provident benefits in favor of the
above named person/s;
6. I am executing this affidavit to attest to the truth of the foregoing facts and
statements.
I further sayeth not.
___________________
Affiant
Witnesses:
_____________________________
____________________________
Printed Name/Signature
Printed Name/Signature
SUBSCRIBED AND SWORN to before me in the ____________________ this _____
day of _______________, _______ by _________________________, who has satisfactorily
proven to me his/her identity through his/her _________________________ valid until
______________________, that he/she is the same person who personally signed before
me the foregoing Waiver of Rights and acknowledged that he/she executed the
same.
NOTARY PUBLIC
Doc. No.
_____________;
Page No.
_____________;
Book No.
_____________;
Series of
_____________.
(March 2012)

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