SPECIAL POWER OF ATTORNEY

KNOWN ALL MEN BY THESE PRESENTS:

I, _____________________________, of legal age, widow, Filipino, with address at

_______________________________, do hereby appoint, name, and constitute
_______________________________, all of legal age, Filipinos, and with postal address at
_________________________, as my true and lawful Attorneys-in-Fact, to act for and in my name, place,
and stead and to perform the following acts and things, to wit:

1. To represent, process, and transact in my behalf before the Social Security System (SSS) in relation
to the application for claim of benefits as the surviving spouse of _______________., with SSS Pensioner
No. ___________________;

2. To secure all SSS records of ____________________;

3. To request, secure, and receive a certified true copy of the Death Certificate _________________
from the Philippine Statistics Authority;

4. To execute, sign, deliver, and receive whatever documents, agreements, or writings as may be
deemed necessary, proper, and convenient for the purposes aforementioned.

HEREBY GIVING AND GRANTING unto said Attorneys-in-Fact full power and authority to do
every act necessary to be done in and above the premises, fully to all intents and purposes as I could do if
personally present, with the power of all substitution or revocation, hereby ratifying and confirming all that
my said Attorneys-in-Fact shall lawfully do or cause to be done by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________ at

_____________________________.

____________________________

SIGNED IN THE PRESENCE OF:

________________________________ ____________________________________
Witness Witness

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

BEFORE ME, this ___________________________, personally appeared ________________ with her

valid proof of identification bearing her photograph and signature as above-indicated under her name, known to me
and to me known to be the same person who executed the foregoing Special Power of Attorney and acknowledged to me
that the same is her free and voluntary act and deed.

WITNESS MY HAND and SEAL on the date and place mentioned above.

Doc. No._______;
Page No._______;
Book No._______;
Series of 2019.