REPUBLIC OF THE PHILIPPINES )

PROVINCE OF DAVAO DEL SUR ) S.S.

MUNICIPLITY OF MALITA. . . . . . )
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WAIVER
WE, LATARCO M. OMBOY and ARLENE O. CAMIA, both of legal
age, married, residents of Barangay Tingolo, Malita, Davao del Sur, father
and sister respectively of the late CALIXTO OMBOY after having been duly
sworn to in accordance with law, do hereby depose and say:
1. That I am the same and identical person who caused the execution of
this instrument;
2. That on May 25, 2013, an incident happened involving our kin the late
CALIXTO OMBOY, and EFREN M. PLACIBE, resulting in the death of the
former;
3. That the kin of the said EFREN M. PLACIBE, namely his father FELIPE L.
PLACIBE and mother CONCHITA M. PLACIBER, ADONIS O. ANG, in
behalf of his son SANDY ANG, has already fully settled his liability to my
son in the amount of FIFTEEN THOUSAND PESOS (P15,000.00);
4. That I hereby release and forever discharge both ADONIS O. ANG and
SANDY ANG from any and all manner of action, causes of action, sum
of money, damages, liability, responsibility, obligation, claims and
demands whatsoever in law or equity, including, but not limited to,
actual, moral, exemplary and all other damages or causes of action
provided for under the law, if any, arising, directly or indirectly, from
the facts and circumstances giving rise to, surrounding or arising from
the said incident;
5. That I hereby also allow, thru this waiver, the PNP-Malita to release the
motorcycle subject of the said incident;
6. That I executed this waiver to attest to the truth of the foregoing
statements;
7. That I executed this waiver freely and voluntarily.
IN WITNESS WHEREOF, I have hereunto set forth my hand this 24 th
day of May 2013 at Malita, Davao del Sur, Philippines.
ALICIA E GUMAYOD
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 24th day of May,
2013 at Malita, Davao del Sur, Philippines. I certify further that I have
personally examined herein affiants and I am satisfied that he understood
the contents hereof and voluntarily executed the same.