SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________________, Filipino citizen of legal age, married, with
residence and postal address at _______________________________________ do hereby name,
constitute, appoint _____________________________, of legal age, single and with office
address at _______________________________as my true and legal representative to act for and
in my name and stead, to do and perform any and all of the foregoing acts and things, namely:
1. To represent, receive/claim any documents/check from the
___________particularly those related to my terminal pay;
2. To make, sign and execute, for and in my behalf, any documents which may be
necessary for the release of my terminal pay; and
3. To receive and encash the check issued by the ______________ in my favor,
representing the full amount of my terminal pay
HEREBY GIVING AND GRANTING unto my said attorney in fact full power and
authority to do and perform all and every act and thing whatsoever requisite and necessary to be
done in and about the premises, as fully, to all intents and purposes, as I might or could do if
personally present and hereby ratifying and confirming all that my said attorney in fact shall
lawfully do or cause to be done by virtue thereof.
IN WITNESS WHEREOF, I hereunto set my hands this _______ day of
________________, 2016, at _________________________.

_________________________________________
Principal

Witness Witness

ACKNOWLEDGMENT

Republic of the Philippines )

_____________________) S.S

BEFORE ME A NOTARY PUBLIC for and in the above jurisdiction personally appeared
_____________________________ with Government Employee No. 9529, known to me and to
me known to be the same person who executed the foregoing instrument which he acknowledged
to be his free act and deed.

Doc. No.: ______;

Page No. ______;
Book No. _____ ;
Series of 2016