SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, NAME OF GRANTOR, do hereby name, constitute, and

appoint NAME OF GRANTEE, of legal age, married, Filipino and a resident
of (address of AIF,) to be my true and lawful attorney, for me and in my name,
place, and stead, to do and perform the following acts or thing, to wit:

(a) To receive my Philippine passport, Passport No. ____ before the Office of the
Department of Foreign Affairs;

HEREBY GRANTING AND GIVING unto my said Attorney-in-Fact full

power and authority to do and perform any and all other acts and things necessary
or proper to be done in and about the premises as fully to all intents and purposes
as I might or could lawfully do if personally present, and hereby ratifying and
confirming all that my said attorney-in-fact shall lawfully do or cause to be done in
my behalf by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 12th

day of March, 2015, at Parañaque City, Philippines.

(Principal)

SIGNED IN THE PRESENCE OF:

____________________________ ____________________________

(witness) (witness)
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

City of Paranaque City ) S.S.

BEFORE ME, on the date and place above written, personally appeared,
with Driving License No. issued on December 3, 2013 at LTO Parañaque
Extension Office, and she acknowledged under oath to me under penalty of law,
that the whole contents therein are true and that the same is her free and voluntary
act and deed.

WITNESS MY HAND AND NOTARIAL SEAL.

Notary
Public

Doc. No: ___________

Page No. ___________
Book No. ___________
Series of _________