SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ___________________, legal age, and residing at
______________________, do hereby constitute, nominate, and
appoint my mother, ____________________, likewise with residence
address at ______________, to be my true and lawful attorney-infact, with full and special power to do and perform the following:

__________________________________________________
_______________________________________________________
_______________________________________________________

HEREBY GIVING AND GRANTING unto said attorney-in-fact full

powers and authority to do and perform every acts and things of
whatever requisite and necessary to be done in and about the
premises, and hereby ratifying and confirming all that my said
attorney-in-fact shall do or cause to be done under and by virtue of
these presents.
IN WITNESS WHEREOF, we have hereunto set our
hands this _________________ at _________________.
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
City of _________________________) S.S.
BEFORE ME, a Notary Public for and in the City of
________________ personally appeared the following persons
exhibiting to me their respective competent evidence of authority, to
wit:
__________________________ __________________________
known to me and to me known to be the same persons who executed
the foregoing Special Power of Attorney, consisting of two (2) pages

including this page on which this acknowledgment is written, and

affirmed that the same is their own free and voluntary act and deed.
IN TESTIMONY WHEREOF, we have hereunto set my hand
and affixed my notarial seal this ________________________ at
________________________.

Doc. No. _____

Page No. _____
Book No. ____
Series of 2015.