WAIVER

I, Leana Virginia O. Pantaleon, Filipino, of legal age, married, and with address at #41
McKinley Hills st. cor. Somerset, McKinley Hills Village, Taguig City. after having been duly sworn
to in accordance with law, depose and state:

1. That _________________________ is currently being treated for drug rehabilitation

at ________________ from ___________ to present.

2. That while under treatment he escaped without completing the period of

rehabilitation.

3. That as his lawful wife I am tasked to look after him and protect him and ensure his
welfare, health and security.

4. Hence, I HEREBY WAIVING filing legal action in connection with his recue and
return to __________________ rehabilitation facility, provided it shall be in humane
circumstances and condition.

IN VIEW WHEREOF, I have hereunto set my hand this ________ day _____ of_________,
at ____________________, Philippines.

Leana Virginia O. Pantaleon

SUBSCRIBED AND SWORN TO before me this _______ day of ___________20__, at

________________. I hereby certify that I have examined personally the person who execute this
waiver and known to me to be the same person who executed the foregoing instrument and exhibiting
to me her ________________ issued in _________ City on __________________. She voluntarily
executed this waiver and understood the same.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _______

Page No. _______
Book No. _______
Series of 20__.