REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU )

WAIVER

I, _______________,of legal age, Filipino, single and a resident of _________, after

having been duly sworn in accordance with law state that:

1. I am the lawful and registered owner of a ________Building situated along

the______________________________;
2. During the joint site inspection conducted by the Road Right of Way Team of the Office
of the ____________________, it was established by actual ground measurement
that my said structure was found to be ______meters from the centerline of national
road;
3. That said ______________has a thirty _________meter wide Road Right Of Way,
which is ______meters from the centerline of the road to both sides and additional
_____meters front setback from the RROW limit for _______buildings;
4. That I hereby WAIVE MY RIGHTS AND PARTICIPATION whatsoever over my said
residential building/structure once the government wishes to use the _____meters
portion of the land which is the setback provided by law by demolishing said structure
at my expense without demanding compensation from the government;
5. That I am executing this waiver in order to establish the veracity of the foregoing
statements and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature this ____day of _____2018 at the
______Cebu, Philippines.

____________________
Affiant
Signed in the presence of:
________________________ _______________________
Witness Witness