Republic of the Philippines)
Province of ____________________) S.S.
City/Municipality of _____________)
x – – – – – – – – – – – – – x
WAIVER OF RIGHTS OVER ELECTRIC POWER LINE
I, _____________, of legal age, Filipino, (single / married / widow), and a resident of _____________, Philippines, after being sworn in accordance with law, hereby declare that I do hereby waive, transfer and convey all my rights, interest and obligations over the electric power line with Account No. _____________ with the _____________ Electric Cooperative to _____________, who is also of legal age, Filipino, (single / married / widow), and a resident of _____________, and who is able and willing to assume all my rights and obligations in connection with the said account with _____________ Electric Cooperative.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.