HDMF

P1-8
SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THIS PRESENT:
That I, ___________________________________, of legal age, single/married and with residence and postal
address at _________________________________________ have named, constituted and appointed, and by these
presents do hereby name, constitute and appoint _____________________________________________ likewise of
legal
age,
single/married
and
with
residence
and
postal
address
at
_________________________________________________ to be my true and lawful attorneyin-fact, for me and in my
name, place and stead, to do and perform any and all of the foregoing acts and things, namely:
1. To file and follow-up my application for the withdrawal of my contributions with the Home Development
Mutual Fund (Pag-IBIG FUND) on account of ____________________________________.
2. To make, sign and execute, for and in my behalf, any documents which may be necessary for the
approval of my application and release of my aforesaid contributions.
3. To received and encash the check due me from Pag-IBIG Fund, by reason of termination of
membership.
4. To make, sign and execute for and in my behalf, any and all documents evidencing receipt of my
aforesaid contribution and to sign and execute in my behalf the Deed of Settlement and Certificate of
Release upon receipt of my contributions thereby releasing Pag-IBIG Fund from any liability whatsoever
by reason of this claim.
GIVING AND GRANTING unto my said Attorney-in-Fact full power and authority to do and perform every act and
thing whatsoever required and necessary to be done as I might or could do if personally present, hereby ratifying and
confirming all that my said Attorney-in-Fact shall lawfully do or cause to be done by virtue of these present.
IN WITNESS WHEREOF, I have hereunto signed my name this _________ day of _______ 20__________ at
_________________.
______________________
Principal
_______________________________
Specimen Signature of Attorney-in-Fact

SIGNED IN THE PRESENCE OF:

____________________________________________

________________________________________

ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES) S.S.
___________________________ )
BEFORE ME, a Notary Public for and in the City/Province of ________________________ this day of
_________________________, 20 _______, personally appeared ________________ with Com. Tax Certificate No.
____________________, issued at _______________ on ________________ a person known to me and to me known to
be same person who executed the foregoing Special Power of Attorney and acknowledge to me to be his/her free and
voluntary act and deed.
WITNESS MY HAND AND SEAL on the date and place above written.

Doc No.
Page No.
Book No.
Series of

_______________;
_______________;
_______________;
_______________.

NOTARY PUBLIC
Until _____________________
PTR No. __________________
Issued On _________________
Issued At __________________